Therapeutic Modalities

Therapeutic ModalitiesWhat are they?

Technique that aids healingImportant adjunct to therapeutic exercise

Why do we use them?Crease optimal environment for injury to healLimit inflammatory processBreak pain-spasm cycle

How do you select a modality?Site, type, severity

Therapeutic ModalitiesIndication

Condition that could benefit from a specific modality

ContraindicationCondition that could be adversely affected from

a specific modality

Therapeutic ModalitiesAll about ENERGY

Electromagnetic Energy- Electromagnetic spectrum Frequency and Wavelength

Inverse relationship between wavelength and frequency Infrared Modalities

Cryotherapy Thermotherapy

Acoustic Energy Needs medium for transmission

UltrasoundOther

Massage, traction, medication

Electromagnetic SpectrumInfrared (Thermal Changes)

Cold packsCold whirlpoolHot whirlpoolParaffinHydrocollator

TransmissionRadiation

Heat is transferred through space Laser

Conduction Heating or cooling through direct contact Hot or ice pack

Convection Heating or cooling indirectly through air or water whirlpool

Conversion Heating through other forms of energy ultrasound

Evaporation Icey Hot

Cryotherapy

Cryotherapy (cold)Infrared Modality

Ice packsIce massageCold whirlpoolIce immersionCold sprays

CryotherapyIndications

Acute injuries (24-72 hrs)Pain controlReduction of spasm

ContraindicationsAllergies (Cold uticaria) or HypersensitivityUncovered woundsArthritis

CryotherapyTransmission of Energy’

Conduction, convection, evaporationTissue cooling

Temperature dependentTissue dependent

Fat, muscleTime dependentType of cooling agent (ice vs. water)Limb circumference

Ice pack is better than the chemical pack

Physiological Response to CryotherapyVasoconstrition of small blood vesselsCooled blood circulates and vasocontriction

continuesHunting Response

Intermittent period of vasodilation after 15-30 minutes of cold application

Lasts for 4-6 minutesProtection form tissue damage- but DOES NOT

raise temperature to pre-application levelsCauses the redness

ChangesDecreases in…

Blood flowMetabolic rateInflammationPain perceptionMuscle spasmMuscle fatigueCollagen elasticity

Increases in…Blood viscosity

Techniques Ice packs

20 minChemical packs

15 minIce massage

5-10 minIce immersion/whirlpool

5-20 minVapocoolant spraysContrast bath

Stages of CoolingStage 1: (0-3 min)

Cold sensationStage 2: (2-7 min)

Mild burning and achingStage 3: (5-12 min

Skin anesthesia

CryokineticsAlternating ice and exercise

Anesthesia allows for pain-free exercise

Thermotherapy

ThermotherapyForms- Superficial and DeepIndications

Chronic injuries and painMuscle spasm/joint stiffness

Contraindications Acute injuriesImpaired sensationsDecreased circulationImpaired thermal regulation

Changes Increases in…

Blood flowMetabolic rateCollagen elasticityCapillary permeability

Decreases in…Pain perceptionMuscle spasmJoint stiffnessBlood viscosity

TechniquesMoist Hot Packs

Water temp. 158- 170 degrees10 min

Whirlpools96-104 degrees20 min

Paraffin Bath118-126 degreesDip and soak OR dip and wrap

Contrast Bath

UltrasoundAcoustical energy transmitted to tissues via a

mediumHigh frequency causes vibrations

Just like waves in the ocean

ElectrotherapyIndications

Pain modulationMuscle contraction

ContraindicationsLoss of sensationOver heart, brain, or spinal cord

MassageMechanical responses

Venous and lymphatic drainageStretching of tissue

Physiological responsesIncrease circulation, metabolism, waste

removalBody relaxation

Psychological responsesHumans respond to being touched

Traction Putting tensions on a body segment Indications

Joint hypomobilityMuscle spasmHerniated discNerve impingement or inflammation

Contraindications Unstable bony structuresPatient discomfort