Therapeutic Modalities

1. Therapeutic Modalities Chapter 12

2. Therapeutic Modalities • Various heating, cooling, and mechanical/electrical methods of treatment used on human body • Hot & cold treatment • Therapeutic ultrasound • Various electrical modalities • Effective application important • If modality used improperly, condition being treated may worsen

3. Modality • Therapeutic agent used to stimulate body tissues to perform their normal function. • Most utilize electromagnetic energy; ultrasound utilizes acoustic energy

4. Modalities • Used in addition to other treatments • Relieve pain • Reduce or retard swelling • Decrease spasm • Promote healing • Can minimize time lost from participation • Help to shorten recovery time

5. 4 Methods of Energy Transmission Conduction • Heat transferred through direct contact • Ice massage • Cryocuff Convection • Heat transferred through movement of fluids or gases • Whirlpool • Fluidotherapy Radiation • Heat is transferred through space • Infrared lamp • Diathermy Conversion • Heat is generated from another source (electrical, sound) • Ultrasound • Estim • Ionto

6. Major Classifications • Cryotherapy—overall temp decreases • Thermotherapy—overall temp increases • Mechanical—utilize forces to affect tissue change • Electrical—utilize electricity to promote tissue function • Sound—utilizes sound wave to promote tissue function

7. Cryotherapy • Most widely used thermal modality in sports medicine • Decrease muscle guarding and spasm • Acute injuries • Vasoconstriction • Reduction of tissue metabolism • Decrease in nerve conduction velocity • Reduction of muscle spasm • Secondary vasodilatation • Increase in muscle strength after treatment

8. Cryotherapy—Ice Packs • Can be made quickly and most economical • Crushed ice preferred • Remove air before tying bag—too much air makes bag difficult to hold in place (ice slides around) • Reusable gel packs appropriate for clinical setting

9. Cryotherapy—Ice Massage • Used for localized problems • Shin splints • UCL sprain • 5 minutes • Can be performed at home • Use paper cup or simply hold ice cube with washcloth

10. Cryotherapy—Cold Water Compression • Cold and compression applied simultaneously • Sleeve secured around injured part & connected to container filled with ice water • Tx time: 15-20 min

11. Cryotherapy—Ice Bath • Immersion allows complete, uniform coverage • Athlete can do some movement exercises (with less discomfort) • Temp: 55-64⁰ F • Tx time: 10 min

12. Cryotherapy—Ice Bath • Athlete may feel the following sensations: • Cold: 0-3 minutes into treatment • Burning: 3-5 minutes • Aching: 5-8 minutes • Numbness: 8-10 minutes

13. Cryotherapy Contraindications • Thermoregulatory problems • Sensory deficits • Hypersensitivity to cold • Impaired circulation • Heart disease • Malignant tissue • Do not apply for longer than recommended time

14. Thermotherapy • Therapeutic heating of tissues • Only appropriate when inflammation stage subsided • Reduce pain • Promote healing • Increase ROM • Muscle relaxation • ↑ vasodilation • ↑ metabolic rate • ↑ capillary pressure/flow • Clearance of metabolites • Oxygenation of tissue

15. Hydrocollator Packs • Moist hot packs used for superficial heating • Kept in warm heated stainless steel container filled with hot water (60-90⁰ C) • Variety of shapes/sizes, easy to apply, cost effective • Tx Time: 10-20 min

16. Thermotherapy Contraindications • Assess condition being treated and injury status • Heat typically not used until 48-72 hours after injury • Acute injuries • Impaired circulation • Areas of diminished sensation • Heat intolerant • Avoided in areas susceptible to increased bleeding

17. Hydrotherapy (Warm Whirlpool) • Form of superficial heating that uses agitated, heated water • Whirlpool: stainless steel or fiberglass tube with attached turbine • Temp: 102-110⁰ F • Tx Time: 10-20 min • Advantage: • Larger area on extremity can be treated • ROM exercise while in WP • Disadvantage: • Extra time/effort to fill and clean • Clinic space • Equipment expense • Body part cannot be elevated

18. Contrast Therapy • Alternating hot and cold water baths to ankle, foot, hand or elbow • Subacute stage (48-72 hrs) • Reduce swelling • Reduce pain • Increase ROM • Tx time: 20 min • Hot—4 min • Cold—1 min • End with cold • Contraindications: • Impaired circulation • Vascular disease • Tendency to hemorrhage

19. Ultrasound (US) • Therapeutic deep heating that uses high-frequency sound waves • Affects tissues at depths up to 5cm • Absorbed by tissue high in protein content • Tendons, ligaments, joint capsules, muscles tissue

20. US Thermal Effects • As US waves pass from tx head into skin, they cause vibration of surrounding tissues • Increased vibration leads to production of heat within tissue • Increase in temp may cause increase in extensibility of structures, reduce pain, promote healing process

21. Ultrasound • Treatment area should be 2-3 times the size of the ERA • Effective Radiating Area • The portion of the transducer that actually produces the sound wave

22. Ultrasound Continuous Pulsed Low-intensity Has non-thermal effects Facilitate tissue repair 20% or 50% duty cycle • Transformed to deep heat within the targeted tissue • 100% duty cycle

23. Ultrasound Terms • Ultrasonic diathermy • Technical term for therapeutic deep-heating modality • Transducer • US head; ultrasonic beam created by vibrating synthetic crystal housed in this metal shield • Coupling Agent • Cream or gel applied to treatment area that provides a medium for sonic waves to penetrate skin

24. Ultrasound Treatment • Move sound head continuously at speed of 2-4cm per second • Movement of transducer should be restricted to area about twice the size of transducer • Stopping sound heard, moving too slowly, or power set too high, may cause discomfort • Treatment length usually 5-10 minutes

25. Ultrasound Contraindications • Fluid-filled cavities • Eyes • Heart • Uterus, Testes • Growth plates • Fracture sites • Artificial joints • Herniated discs

26. Electrical Modalities • Methods that pass electrical currents through skin for therapeutic uses • Achieve effects by stimulating nerve tissues • Do not produce heat or cold • Use pulsed direct current or alternating current

27. Electrical Modalities Electrical Stimulation Transcutaneous Electrical Nerve Stimulation TENS Reduce pain by stimulation sensory and pain-signaling nerves • E-Stim • Produce muscle contractions and muscle facilitation by electrically stimulation motor nerves • aka neuromuscular stimulation (NMS)

28. Electrical Stimulation Therapy • Effective uses: • Increase range of motion • Increase muscle strength • Reeducate muscles • Improve muscle tone • Enhance function • Control pain • Accelerate wound healing • Reduce muscle spasm

29. Types of Electrical Stimulation • NMES • Neuromuscular electrical stimulation • Most common type of stim • Uses electricity to stimulate a peripheral nerve and to cause either a sensory or motor response • FES • Functional electrical stimulation • Use to improve function • TENS • Commonly applied with portable unit for pain control • Almost all E-Stim units are TENS units

30. Electrical Stimulation Therapy • Electric current applied through surface electrode pad in contact with external skin • Two electrodes required; four can be used • Electrodes placed some distance away from injury site • Different parameters to control type of current being delivered to athlete

31. Electrical Stimulation Contraindications • Carotid sinus • Pregnancy • Individuals with pacemakers • People sensitive to electricity • Any time active motion

32. Mechanical • Massage • Mobilization • Vibration • Manipulation

33. Combo