© 2011 McGraw-Hill Higher Education. All rights reserved Chapter 15: Using Therapeutic Modalities.

© 2011 McGraw-Hill Higher Education. All rights reserved

Chapter 15: Using Therapeutic Modalities

Therapeutic modalities can be an effective adjunct to various techniques of therapeutic exercise

Knowledge of the healing process is critical

A variety of modalities can be utilized by athletic trainers including cryotherapy, electrical stimulation, ultrasound, massage, traction, diathermy, lasers and magnets


Classification of Therapeutic Modalities

Electromagnetic Includes cryotherapy, thermotherapy, electrical

stimulating currents, diathermy and lasersRely on electromagnetic energy, which travels at the

speed of lightEnergy travels in a straight lineThe energy can be absorbed, refracted, reflected or

transmitted


AcousticUltrasound utilizes acoustic energyHigh frequency sound wavesRelies on molecular collisions for energy transferVibration of tissue produces heat and impacts cell

membrane permeability

MechanicalTraction, intermittent compression, massage Involves mechanically stretching, compressing and

manipulating soft tissue and joint structures



Electromagnetic Modalities

ThermotherapyPhysiological Effects of Heat

Dependent on type of heat energy applied, intensity of energy, duration of exposure and tissue response

Heat must be absorbed to increase molecular activityDesired effects

Increase collagen extensibility; decreasing joint stiffness; reducing pain; relieving muscle spasm; reduction of edema and swelling; increasing blood flow


Extensibility of collagenPermits increases in extensibility through stretching

Pain reliefActivates gate control mechanism

Muscle spasmIncreased blood flow reduces ischemia

Assistance w/ healing processRaises tissue temperature, increases metabolism resulting in

reduction of oxygen tension, lowering pH, increasing capillary permeability and releasing bradykinins and histamine resulting in vasodilation

Parasympathetic impulses stimulated by heat are also believed to be a reason for vasodilation


Superficial HeatForm of electromagnetic energy (infrared region of

spectrum) Increases subcutaneous temperature, indirectly

spreading to deeper tissueMuscle temperature increases through reflexive effect

of circulation through conductionMoist heat versus dry heat?


Transmission of Thermal EnergyConduction

Heat is transferred from a warmer object to a cooler oneDependent on temperature and exposure timeTemperatures of 116.6o F will cause tissue damage and

temperatures of 113o F should not be in contact w/ the skin longer than 30 minutes

Examples include moist hot packs, paraffin wax, ice packs and cold packs


ConvectionTransfer of heat through movement of fluids or gasesTemperature, speed of movement, and conductivity of

part impact heatingExample: Whirlpools

RadiationHeating is transferred from one object through space to

another objectShortwave diathermy, infrared heating and ultraviolet

therapy

ConversionGeneration of heat from another object Example: sound, electricity or chemical agents


Hydrocollator Packs

EquipmentSilicate gel or clay pads

submersed in 160-170o F water

Maintains heat for 10-20 minutes


Figure 15-1

IndicationsUsed for general muscle relaxation and reduction

of pain-spasm-ischemia-hypoxia-pain cycleLimitation - unable to heat deeper tissues

effectively

ApplicationPack removed from water; covered w/ 6 layers of

toweling which are removed as cooling occurs; area treated for 15-20 minutes

Athlete must be comfortable and should not lay on pack


Whirlpool BathEquipment

Varying sizes used to treat a variety of body partsTank w/ turbine that regulates flow Agitation (amount of movement) is controlled by air emitted

IndicationsCombination of massage and water immersionProvides conduction and convection Swelling, muscle spasm and pain

ApplicationTemperature is set according to treatment goalsAthlete should be set up to be reached by agitator (8-12” from

agitator) Do not place directly on injured site

Maximum treatment time for acute injuries should not exceed 20 minutes



Special Considerations Must be careful with full-

body immersionProper maintenance is

necessary to avoid infection

As volume of body part immersion increases, temperature should decrease

Safety is a major concernElectrical outletsAthlete should not turn

whirlpool on or offContraindicated for acute

injuries due to gravity dependent position

Figure 15-2

Paraffin BathEquipment

A paraffin wax and mineral oil combination, heated to 126-130o F, plastic bags, paper towels and towels

IndicationsUseful in treating chronic injuriesEffective for angular areas of body such as hands, wrists,

elbows, ankles and feetApplication

Body part is cleaned and driedDip and wrap technique

Hand dipped 6-12 times, wrapped in a plastic bag and then draped w/ a towel to maintain heat for 30 minutes

Soak technique Body part remains in wax 20-30 minutes w/out moving it


FluidotherapyEquipment

Unit which contains cellulose particles through which warm air is circulated

Allows for high heating (higher than water and paraffin) Indications

Used to treat distal extremities in effort to decrease pain, increase ROM and decrease swelling and spasm

ApplicationTemperature ranges from 100-113o FParticle agitation should be controlled for comfortPatient should be comfortableTreatment time = 15-20 minutesExercise can be performed while in cabinet



Figure 15-3 Figure 15-4

Special Consideration w/ Superficial Heat

Important contraindications

Never apply heat when there is loss of sensation

Never apply heat immediately after injury

Never apply heat when there is decreased arterial circulation

Never apply heat directly to eyes or the genitals

Never heat the abdomen during pregnancy

Never apply heat to a body part that exhibits signs of acute inflammation



CryotherapyUsed in first aid treatment of trauma to the

musculoskeletal system

When applied intermittently w/ compression, rest and elevation it reduces many adverse conditions related to inflammation and the reactive phase of an acute injury

RICE (rest, ice compression, elevation) may be used for the initial days of and injury and continue up to 2 weeks after injury


Physiological Effects of ColdType of electromagnetic energy (infrared radiation)Relies on conduction -- degree of cooling depends on

the medium, length of exposure and conductivityAt a temperature of 38.3oF, muscle temperature can be

reduced as deep as 4cmTissue w/ a high water content is an excellent

conductorMost common means of cold therapy are ice packs and

ice immersionWet ice is a more effective coolant due to the energy

required to melt ice


Vasoconstriction Reflex action of smooth muscle due to sympathetic

nervous system and adrenal medulla

Hunting responseIntermittent period of vasodilation will occur if cooling

continues for >20 minutes

Blood viscosity will also increase with extended cooling

Decreases extent of hypoxic injury to cellsDecreases cell metabolic rate and the need for oxygen

through circulation, resulting in less tissue damageDecreased metabolic rate and vasoconstriction

decreases swelling associated w/ inflammatory response


Decreases muscle spasmMuscle becomes more amenable to stretch as a result of

decreased GTO and muscle spindle activity

Decreases free nerve ending and peripheral nerve excitabilityAnalgesia caused by raising nerve threshold

Cold is more penetrating than heat Ability to decrease muscle fatigue and increase and

maintain muscular contractionAttributed to the decrease of local metabolic rates and

tissue temperature


Ice Massage Equipment

Foam cup with frozen water - creating a cylinder of ice (towel will be required to absorb water)

IndicationsUsed over small muscle areas (tendons, belly of

muscle, bursa, trigger points)Application

Ice is rubbed over skin in overlapping circles (10-15 cm diameters) for 5-10 minutes

Patient should experience sensations of cold, burning, aching, & numbness --when analgesia is reached athlete can engage in rehab activities

Special considerationsKeep in mind comfort of the athlete during treatment


Cold or Ice Water ImmersionEquipment

Variety of basins or containers can be used, small whirlpoolTemperature should be 50-60 degrees F

IndicationsCircumferential cooling of a body part

ApplicationPatient immerses body part in water and goes through four

stages of cold responseTreatment may last 10-15 minutesOnce numb, body part can be removed from immersion and

ROM exercise can be performedAs pain returns re-immersion should take placeCycle can be repeated 3 times


Cold or Ice Water Immersion (continued)Special Considerations

Cold treatment makes collagen brittle -- must be cautious with return to activity following icing

Be aware of allergic reactions and overcooling


Ice Packs (Bags)Equipment

Wet ice (flaked ice in wet towel)Crushed or chipped ice in self sealing bag

Not as efficient, but less messyUseful for approximately 15-20 minutesTowel should be placed between skin and pack

Chemical Cold packsGel packLiquid pack

IndicationsAthlete experiences four stages of

cooling and then proceeds with ROM exercises© 2011 McGraw-Hill Higher Education. All rights reserved

Special Considerations Avoid excessive cold

exposure With any indication of

allergy or abnormal pain, treatment should be stopped

When using gel packs, a single layer of toweling should be used

Crushed or flaked ice can be directly applied to skin


Figure 15-6

Vapocoolant SpraysEquipment

Fluori-methane - non-flammable substance that is released in fine spray from pressurized canister

IndicationsReduces muscle spasm, increases ROM, effective on

trigger point

ApplicationFor spasm and ROM

Hold can 12-18 inches from skin, treat entire length of muscle - covering an area 4 inches/second

Apply spray 2-3 times, while gradually applying a stretch


Vapocoolant Spray (continued)Application

For trigger points Locate trigger point

Position athlete in relaxed position; place muscle on stretch; apply spray in specific region and over the length of the muscle

Apply passive stretch while spraying

After first session, heat area and then repeat if necessary

When stretch is complete, have athlete move limb throughout ROM; but do not overload


CryokineticsTechnique that combines cryotherapy with exerciseGoal is to numb region to point of analgesia and work

towards achieving normal ROMEquipment

Treat area with ice pack, massage or immersion

ApplicationWhen analgesia is experienced, exercises should be

performed (window will last 4-5 minutes)As pain returns, process may be repeatedSequence can be repeated 5 timesExercises should be pain freeChanges in intensity should be limited by both healing and

patient’s perception of pain© 2011 McGraw-Hill Higher Education. All rights reserved

Special Considerations for CryotherapyCooling for an hour at 15.8o - 30.2o F produces

redness and edema that lasts for 24 hours post exposure

Immersion at 41oF increases limb fluid volume by 15%

Exposure for 90 minutes at 57.2o - 60.8o F can delay resolution of swelling up to one week

Some individuals are allergic to cold and react w/ hives and joint pain

Icing through a towel or bandage limits the reduction in temperature -- could limit effectiveness of treatment


Special medical conditionsRaynaud’s phenomenonParoxysmal cold hemoglobinuria

Application of ice (very rare) can cause nerve palsyMotor nerves close to skin overexposed to cold (peroneal

nerve at head of fibula)


Electrical Stimulating CurrentsPhysical Properties of Electricity

Electricity displays magnetic, chemical, mechanical, and thermal effects on tissueVolume of current (ampere)Rate of flow of 1 amp = 1 coulomb Resistance = ohmsForce that current moves along = voltage

Electricity is applied to nerve tissue at certain intensities and duration to reach tissue excitability thresholds resulting in membrane depolarizationTarget sensory, motor, and pain nerve fibers in an effort

to produce specific physiological effects


EquipmentThree types of units

TENS - transcutaneous electrical nerve stimulatorsNMES/EMS - neuromuscular electrical stimulators or

electrical muscle stimulatorsMENS/LIS - microcurrent electrical nerve stimulators or

low-intensity stimulators

Generate 3 types of currentMonophasic

Direct current or galvanic current - flow in one direction only from (+) to (-) or vice versa

Used to produce muscle contraction, pain modulation, ion movement (determined by specific parameters)


Biphasic Alternating current where direction of flow reverses during

each cycle

Useful in pain modulation and muscle contractionsPulsatile

Pulsed currents usually contain three or more pulses grouped together

Generally interrupted for short periods of time and repeat themselves at regular intervals

Used in interferential and so-called Russian currents

Current ParametersWaveforms

Different generators have differing abilities relative to the production of various waveforms

A graphical representation of shape, direction, amplitude and direction of current

Can be sine, square or triangular in shape


Figure 15-9© 2011 McGraw-Hill Higher Education. All rights reserved

Figure 15-10

ModulationAbility of stim unit to change or alter the magnitude

and duration of a waveformMay be continuous, interrupted or surged for both AC

and DC currents Intensity

Voltage output of stimulating unitHigh and low voltage units

Duration (pulse width or pulse duration)Refers to the length of time that current is flowingPre-set on most high voltage DC units

FrequencyNumber of waveform cycles per second


PolarityDirection of flow -- either positive or negative

Electrode Set-upUse of moist electrodes fixed to the skinCan include monopolar (active and dispersive pad) or

bipolar set-upCurrent generally felt under and between both pads

unless monopolar set-up is used --then current is felt under the smaller active pad


IndicationsPain Modulation

Gate Control Intensity should produce tingling w/out a muscular contraction High frequency and pulse duration

Descending Pain Control High current intensity approaching noxious Pulse duration of 10 msec; frequency should be 80 pps

Opiate Pain Control Theory Point stimulator should be used with current intensity set as

tolerable Pulse duration should be at maximum; w/ a frequency of 1-5

pps


Muscle Contraction Quality of contraction will change according to current

parameters Increased frequency results in increased tension (50pps

results in tetany) Increased intensity spreads current over larger area Increased current duration causes more motor unit activation

Muscle pump Used to stimulate circulation High-volt, DC stimulator; 20-40 pps; surge mode (on/off 5

seconds each; elevation w/ active contraction Treatment time 20-30 minutes


Muscle strengtheningHigh frequency AC current; 50-60 pps; 10:50

seconds on/off ratio; 10 repetitions 3x per week; perform with active contractions

Retardation of atrophyHigh frequency AC current 30-60 pps; w/

voluntary muscle contraction encouraged; 15-20 minutes

Muscle re-educationLevel of comfortable contraction -- 30-50 pps;

w/ either interrupted or surge currentAthlete should attempt to contract muscle

along w/ stimTreatment time 15-20 minutes and repeated

multiple times over the course of a week© 2011 McGraw-Hill Higher Education. All rights reserved

Types of Settings

Iontophoresis Introduction of ions into body tissue via direct electrical

currentEquipment

Iontophoresis generator which produces a continuous monophasic current

IndicationsUsed to treat musculoskeletal inflammatory conditions,

analgesic effects, scar modification, wound healing, calcium deposits, hyperhidrosis

MedicationDexamethasone and hydrocortisone are two commonly

used


ApplicationReusable or commercially produced electrodesThree application techniques

Active pad over medication saturate gauze Body part and active electrode submerged in tub of ion solution Special active electrode with medication reservoir

Utilize large dispersive padMovement of positively and negatively charged ions

relative to electrode charges (poles)Treatment last 10-20 minutes depending on current

intensity and ion concentrations in solutionRequires use of low voltage direct current on

continuous mode w/ a long pulse duration (allows for migration of ions)

Must be careful to avoid chemical burns and certain to utilize appropriate medications for specific conditions


Interferential CurrentsEquipment

Uses 2 separate generators, emitting current at slightly different frequencies

Quad polar pad placement is used, creating interference pattern

Creates a broader area of stimulation Indications

Pain control (including joints), swelling, neuritis, retardation of callus formation following fracture & restricted mobility

ApplicationPads must be placed to ensure that current is

centered over painful areaSimilar treatment parameters can be used


Low Intensity StimulatorsEquipment

Micro-current electrical nerve stimulatorOperates at low frequencies and intensities (sub-sensory)

IndicationsUsed to stimulate healing of soft tissue and boneModulate pain, promote wound healing, promote non-

union fracture healing, tendon and ligament healingBased on theory, little research support

ApplicationUtilizes same electrical currents as previously describedUsing large dispersive pad maintains current density at

thresholds which will not result in sensory nerve depolarization


Ultrasound TherapyModality which stimulates repair of soft tissue and

pain relief

Form of acoustic energy used for deep tissue heatingOperates at inaudible frequencySound scatters and is absorbed as it penetrates tissues

-- losing energy = attenuation Impedance and penetration are determined by

properties of media (densities)


EquipmentHigh frequency generator which provides

electrical current through a coaxial cable to a transducer applicator

Through piezoelectric effect electrical current is transformed into acoustic energy through contraction and expansion of piezoelectric crystals

Frequency ranges between .75 and 3.0 MHz1 MHz ultrasound allows for deeper penetration

while 3 MHz is absorbed more superficially


Area of transducer that produces sound is the effective radiating areaProduces a beam of acoustic

energy - collimated cylindrical beam with non-uniform distribution

Variability in the beam (beam non-uniformity ratio - BNR) =lower BNR = more uniform energy output

Intensity is determined by amount of energy delivered to the sound head (W/cm2)

Can be delivered as either pulsed or continuous ultrasound


Figure 15-14

IndicationsProduces thermal and non-thermal effects

Generally used for tissue heating (must increase tissue temp between 104o and 113oF

Non-thermal effects include microstreaming and cavitation which impacts tissue permeability and fluid movement - useful with acute injuries For solely non-thermal effects, intensity must remain below .2

W/cm2

Frequency resonance hypothesis relates to alterations in protein signaling frequency which impact permeability, healing and protein production

Acute conditions require more treatments over a shorter period and chronic conditions require fewer treatments over a longer period


ApplicationDirect skin application

Requires a coupling medium to provide airtight contact w/ skin and a low friction surface

Underwater applicationUsed for irregularly shaped structuresBody part is submerged in water, ultrasound head is

placed 1” from surfaceWater serves as coupling medium, air bubbles should be

continually swept awaySound head should be moved in circular or longitudinal

patternShould be performed in non-metal container to avoid

reflection


Gel pad techniqueUsed when body part can not be immersed in waterGel pad applied to treatment areaCoated with gel to enhance contact surface

Moving the transducerLeads to more even distribution of energy, reducing

likelihood of hot spotsShould be moved at a rate of 4cm/secondMust maintain contact of transducer with surface of skinCircular or stroking patterns should be usedShould not treat an area larger than 3 times the ERA


Dosage and TimeVaries according to depth of tissue to be treated and the

state of injuryDuration tends to last 5-10 minutesIntensity varies

Low 0.1-0.3 W/cm2

Medium 0.4 - 1.5 W/cm2

High 1.5 - 3.0 W/cm2

Special ConsiderationsWhile it is a relatively safe modality, precautions still must

be takenBe careful with anesthetized areas, reduced circulationAvoid high fluid regions of the body, acute injuries, and

epiphyseal areas of children


Ultrasound in Combination w/ Other Modalities

Ultrasound can be used w/ a variety of modalities to accomplish a series of treatment goalsUse of hot packs with ultrasound may have an additive

effect on muscle temperatureCold packs, while often used in conjunction with

ultrasound, may interfere with heating With electrical stimulation, it is often useful for trigger

point treatment (blood flow, muscle contraction and pain modulation)



Figure 15-15

PhonophoresisMethod of driving molecules through the

skin using mechanical vibrationProcess which moves medication to injured tissues

IndicationsPrimarily used to drive hydrocortisone and anesthetics

into the tissueUsed on trigger points, tendinitis and bursitisEffectiveness of treatments is still being exploredGenerally involves the use of a 10% hydrocortisone

ointment (rubbed into the area), followed by application of coupling medium and ultrasound treatment

Chem pads are also available


Mechanical Modalities


TractionDrawing tension applied to a body segment

Physiological EffectsProduces separation of vertebral bodies impacting

ligaments, capsules, paraspinal muscles; increases articular facet separation, and relief of nerve root pain; decreases central pressure of vertebral disks; increases proprioceptive changes; relief of joint compression due to normal posture


IndicationsSpinal nerve root impingementDecrease muscle guarding, treat muscle strainTreat sprain of spinal ligamentsRelax discomfort from normal spinal compression

ApplicationManual and traction machines can be usedManual

Adaptable and allows for great flexibilityChanges in force, direction, duration and patient

positioning can be made instantaneously


Mechanical TractionCan be used to apply cervical or lumbar traction

Positional TractionUsed on trial and error basis to determine maximum position of

comfort to accomplish specific goal

Wall-Mounted TractionCervical traction can be accomplished w/ this unitInvolves use of plates, sand bags or water bags for weightRelatively inexpensive and effective

Inverted TractionUtilizes special equipment or simply inverting ones selfWeight of trunk lengthens spine, providing a stretch



Figure 15-17

Figure 15-19


Figure 15-16 Figure 15-

18

Intermittent Compression Units

EquipmentUtilizes nylon inflatable sleeve Sleeve is inflated to specific pressure using either water

or airUtilized to facilitate movement of lymphatic fluids

ParametersAble to adjust on/off time, pressure and treatment time


IndicationsUsed for controlling or reducing

swelling after acute injuryGood for pitting edema, which

develops several hours after injuryElevation of extremity is critical to

effective treatmentWith electrical stimulation, muscle

pumping can be incorporated to facilitate lymphatic flow


Figure 15-20

On/Off TimeWill often vary (1:2, 2:1, or 4:1)Not research based

PressuresMust be mindful of blood pressureUpper extremity 30-50 mm HgLower extremity 30-60 mm Hg

Some units allow for combining cold along with compression

Electric stim can also be combined during some treatments



Cryo-CuffUses both compression

and cold simultaneouslyElevation of cooler results

in increased cuff pressureAlso allows for circulation

of cooler waterPortable and easy to use

Game Ready SystemCirculates water with

compressionCan be customized for

various time, temperature and compression settings

Figure 15-21

MassageSystematic manipulation of soft tissue

Therapeutic EffectsMechanical Responses

Occur as a direct result of pressures and movementsEncourages venous flow and mild stretching of superficial

tissuePhysiological Responses

Increases circulation aiding circulation, removal of metabolites, overcoming venostasis

Reflex effect - response to nerve impulses initiated through superficial contact Impacts body relaxation, stimulation, and increased

circulation


Relaxation can be induced by slow superficial stroking of skin

Stimulation achieved by quick brisk strokes, causing contraction of tissue Primarily psychological impacts

Increased circulation through reflexive and mechanical stimuli Capillary dilation, stimulation of cell metabolism,

decreasing toxins and increase lymphatic and venous circulation

Psychological ResponsesTactile system is one of the most sensitive systems

of the bodyBecause the laying on of hands is used w/ massage

it can be an important means of creating a bond of confidence between the athlete and the clinician



Application

EffleurageStroking divided into

light and deep Can be used as a

sedative or to move fluids

Multiple stroking variations exist

Pressure variations

Figure 15-22

Figure 15-23


PetrissageKneadingInvolves picking up

skin between thumb and forefinger, rolling and twisting in opposite directions

Used for deep tissue work Figure 15-25


FrictionUsed around joints and in areas where tissue is thinAreas w/ underlying scarring, adhesions, spasms and fasciaGoal is to stretch underlying tissue, develop friction and

increase circulation

Figure 15-26

TapotementCupping

Produces invigorating and stimulating sensation

Series of percussion movements rapidly duplicated at a constant tempo

Hacking Used to treat heavy muscle areas, similar to cupping

Pincing Lifting of small amounts of tissue between thumb and first

finger in quick, gentle pinching movements

VibrationRapid movement that produces quivering or trembling

effect to tissueUsed to relax and soothe


Figure 15-27


Special ConsiderationsMake the patient comfortable

Positioning, padding, temperature, privacy

Develop confident, gentle approach to massageGood body positioning (clinician and athlete) an develop

good technique

Stroke towards heart to enhance lymphatic and venous drainage

Know when to avoid massageAcute conditions, skin conditions, areas where clots can

become dislodged


Sports MassageUsually confined to a specific area - rarely

given to full bodyFull body massage is time consuming,

generally not feasibleFive minute treatment can be effectiveMassage lubricants

Enables hands to slide and move easily over body, reducing friction

Rubbing dry area can irritate skinMediums include powder, lotion, oil or liniments

Positioning of AthleteArea must be easily accessible and must be relaxed

Exhibit Confidence


Ensure Patient Privacy and Athletic Trainer IntegrityDue to direct physical contact professionalism must be

maintained at all timesCritical when dealing with patient of opposite sexBe sure that area being treated is the only area

exposedAn additional athlete or athletic trainer should also be

present


Deep Transverse Friction MassageTransverse or Cyriax method used to treat muscle,

tendon, ligaments and joint capsulesGoal is mobilization of soft tissueGenerally precedes activityMovement is across the grain of the affected tissueAvoid treatment with acute injuriesTreatment will produce numbing effect allowing for

exercise mobilization


Acupressure MassageBased on Chinese art of acupuncturePhysiological explanation and effectiveness may be

based on pain modulation mechanismsClinician can utilize acupuncture points in treatmentLocate through measurement of electrical

impedance or palpationSmall circular motions are used to treat points

(pressure to tolerance of athlete = generally more pressure = more effective treatment)

Treatment time ranges from 1-5 minutesCan treat one or more points, working distal to

proximalWill produce dulling or numbing sensation w/ results

lasting from minutes to hours© 2011 McGraw-Hill Higher Education. All rights reserved

Magnet TherapyBecoming popular amongst

competitive and recreational athletes

Used in cases of musculoskeletal ailments

Limited research on magnetic therapy

Utilizes magnetic fields to physiologically impact bodyChange polarity of damaged cells, increase blood

flow, increase muscle strength and hormone secretion, increase cell division and enzyme activity, increase lymphatic flow and alter blood pH© 2011 McGraw-Hill Higher Education. All rights reserved

Recording Therapeutic Modality Treatments

Specifics of treatment should be recorded on original SOAP note, progress note and treatment log

Changes in treatment parameters and modalities should always be noted


Safety in Using Therapeutic Modalities

Equipment must be used and maintained in appropriate manner

Following manufacturer recommendationsRegarding use and maintenance

Failure to follow recommendations = negligence


Evidence-Based Data Regarding Therapeutic

Modality UseClinical effectiveness has yet to be established

for a variety of conditions

Often rely on efficacy generated by manufacturers rather than research

Minimal modality-related evidence-based information availableEvidence should be carefully questioned and

consideredBest evidence should be put into practice


© 2011 McGraw-Hill Higher Education. All rights reserved Chapter 15: Using Therapeutic Modalities.

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Transcript of © 2011 McGraw-Hill Higher Education. All rights reserved Chapter 15: Using Therapeutic Modalities.