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