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Therapeutic Modalities

Therapeutic Modalities. Introduction. Therapeutic modalities create an optimal environment for injury repair (DO NOT “CAUSE HEALING”) Most common types of modalities Cryotherapy (cold) Thermotherapy (heat) Massage Electrical stimulation Therapeutic ultrasound. Physiology Basics.

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Therapeutic Modalities

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  1. Therapeutic Modalities

  2. Introduction • Therapeutic modalities create an optimal environment for injury repair (DO NOT “CAUSE HEALING”) • Most common types of modalities • Cryotherapy (cold) • Thermotherapy (heat) • Massage • Electrical stimulation • Therapeutic ultrasound

  3. Physiology Basics • Vasodilation • Increased size of vascular structures • Means more oxygen to the tissue • Vasoconstriction • Decreased size of vascular structures • Useful for preserving compromised/injured cells/tissue

  4. Physiology Basics • Analgesia • Diminished/reduced sensation • Metabolic rate • Activity level of cells • Reducing MR can preserve cells damaged by injury • Inflammation • Series of events that hinder optimal function

  5. Cryotherapy (Ice) • Physiological effects • Decreased local metabolic rate • Important in preventing secondary hypoxic injury • Decreased local blood flow • Vasoconstriction • Decreased presence of inflammation & the processes of inflammation

  6. Cryotherapy (Ice) • Physiological effects • Reduced swelling • Decreased nerve conduction velocity • Analgesia- pain decreased

  7. Cryotherapy (Ice) • Indications • Acute injuries • After activity • Swelling • Spasm • Pain • Mild burns

  8. Cryotherapy (Ice) • Contraindications • Hunting response • Prolonged exposure to cold may lead to superficial vasodilation to protect cold bodypart • Raynaud’s phenomenon • Cold allergy

  9. Cryotherapy (Ice) Application • Ice massage • 7-10 minutes • Excellent for muscle spasm and deep soreness

  10. Cryotherapy (Ice) Application • Ice bags, ice towels, or cold packs • 15-20 minutes (no longer than 30) • If using packs, be sure to avoid direct contact to protect skin! • Cold whirlpool / ice immersion • 5-15 minutes, 55-65 degrees • Duration and temperature depends on surface area immersed

  11. Thermotherapy (Heat) • Physiological effects • Increased local circulation • Vasodilation • Increased local metabolic rate • Increased collagen extensibility • Increased nerve conduction velocity • Analgesia

  12. Thermotherapy (Heat) • Indications • Sub-acute injury • Prior to activity • Reduce spasm/guarding • Contraindications • Acute injury • Impaired sensation

  13. Thermotherapy (Heat) • Application • Warm whirlpool • Treat 15-20 minutes (no longer than 30) • 98-110 degrees • Contrast baths • Switch back and forth between hot and cold 3:1 or 4:1 to induce “vascular pumping action” from repeated vasodilation/vasoconstriction • Particularly useful for troublesome swelling or edema

  14. Thermotherapy (Heat) • Hydrocollator packs • Treat 20 minutes • 150-160 degrees • Will burn! Must pad with layered towels or covers!

  15. Thermotherapy (Heat) • Paraffin bath • Great for angular extremities (hands & feet) • 125-127 degrees • Wash body part • Dip body part 4-5 times, then wrap in ice bag and towel • Treat 20-30 minutes • Dispose of wax or return to bath for re-use • Do not use with open wounds

  16. Massage • Physiological effects • Increased local blood flow (if done properly) • Increased venous/lymph return • Analgesia & sedative neurological effect • Indications • Sub-acute injury • Soreness • Persistent swelling

  17. Massage • Contraindications • Acute injury (may disturb clotting mechanism) • Fracture sites • Open wounds

  18. Types of TherapeuticMassage • Effluerage • Petrissage • Tapotement • Vibration • Cross-friction

  19. Effluerage • Slow, rhythmic, soothing strokes toward the heart • One hand always in contact w/ patient • Use massage lotion or cream, gloves optional • Helps calm/soothe athlete • Encourages venous & lymph return

  20. Petrissage • Deeper “kneading” of large muscle masses • Stimulates local circulation • Eliminates muscle trigger points

  21. Tapotement • Percussion, cupping, or hacking of the large muscle groups • Typical “health-spa” massage • Invigorates- increases neural response • Increases local circulation

  22. Vibration • Rhythmic oscillations of larger muscle groups • Most often quads and hams • Physiologically speaking, we are not really certain of its effects • Perhaps largest benefit is psychological

  23. Cross-friction • Best empirically-supported technique • Increases local blood flow • Reduces sensation of pain • Accommodation • Useful in restoring full function & ROM • Typical treatment lasts 5 minutes

  24. Electrical Stimulation • Many types available • Transcutaneous Electical Nerve Stimulation (TENS) • Useful for pain relief • Portable units are very affordable • Typically treat for 20 minutes

  25. Electrical Stimulation • Many types available • Interferential quad polar (IFQP) • Uses four pads • Good for pain control • Premodulated Bipolar (PMBP) • Uses two pads • Good for pain control when IFQP not ideal (small body parts, etc)

  26. Electrical Stimulation • Other types also available • Settings: • Higher frequencies tend to produce fast acting, comfortable treatment for acute injuries, while lower frequencies tend to elicit longer lasting relief for chronic injuries • Typical treatment lasts 15 minutes at intensity of comfort for patient

  27. Therapeutic Ultrasound • Sound energy which results in deep heating to tissue • May penetrate up to 3-5 cm when administered a 1 MHz, up to 1-2 cm at 3 MHz. • Must keep ultrasound head moving to prevent burns • Typical treatment lasts 5-6 minutes at intensity of 1-1.5 w/cm2

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