Ch. 12 Therapeutic Modalities

Objectives Explain the use and effectiveness of

physical modalities.

Describe the various thermal modalities and their applications.

Explain and describe the use of therapeutic ultrasound.

Explain and describe the use of electrical modalities.

Modalities

Various heating, cooling, and electrical methods of treatment used to promote healing

In order to be effective, modalities should be applied properly

Helps relieve pain, reduce swelling, decrease spasm, minimize time lost from sports

Cryotherapy

Use of cooling agents

Ice packs

Ice massage

Cold whirlpool

Coldwater Compression

Always monitor athlete

Contraindications Thermoregulatory

problems

Sensory deficits

Hypersensitivity

Impaired circulation

Heart disease

Malignant tissue

Why ice?

EffectsVasoconstrictionReduce tissue metabolismDecrease nerve conduction

velocity Reduce muscle spasm

Always use ice for acute injuries

Ice Bag Easy to make, readily

available, cheap

No air should be in bag

May be wrapped on body

Reusable ice packs are better for clinical setting

Time: 20 minutes

May use thin barrier between ice and skin

Ice Massage

Freeze water in a paper cup

Reusable plastic cups

Ideal for tendonitis, shin splints

Time: 5-7 minutes

Cold Whirlpool Immersing body

part in cold water (50°F-60°F)

Covers the whole body part

Athlete may move body part while receiving treatment

Time: 10 minutes

Cold Compression Unit

Many different units that provide cold and compression to shoulders, knees, and ankles

Some use a pump and some uses gravity

Time: 15-20 minutes

Heating Agents

Superficial and deep tissue heating

Effects Reduce pain

Increase range of motion

Muscle relaxation

Increased vasodilation

Only use with subacute or chronic injuries

Heat Packs

Moist heat packs are kept in a hydrocollator

Water temp. 140°F to 194°F

Cover heat pack before placing on body

Should be warm but not burn

Time: 10-20 minutes

Warm Whirlpool Immersing body

part in warm water (95°F to 104°F)

Larger part of the body may be treated

Athlete may move during treatment

Time: 10-20 minutes

Contrast Therapy

Alternating hot and cold therapy

Used in subacute stage to reduce swelling, reduce pain, and increase range of motion

Ultrasound Deep heating

modality

High frequency sound wave

Can affect tissue up to 5 cm

Ideal for tendons, ligaments, and joint capsules

Time: 5-7 minutes

Ultrasound Effects

Increased nerve conduction velocity

Increased extensibility of collagen rich structures

Increased blood flow

Tissue regeneration

Stimulating phagocytosis

Synthesis of collagen

Contraindications

Acute injuries

Ischemic areas

Anesthetic areas

Over cancerous tumors

Over active infections

Over spinal cord

Over fracture sites

Around eyes, heart, skull

Ultrasound Set-Up

Transducer head: 1 cm², 5 cm², 10 cm² Depends on availability and treatment area

Frequency: 1MHz for deep tissue, 3MHz for superficial

Continuous or pulsed setting (Duty Cycle)

Must use coupling agent

Move sound head at 2-4 cm/sec

Electrical Stimulation

Use of electrical currents to stimulate the muscle to cause contractions or spasms

Different types of currents

Different set-ups Interferential

Pre-modulated

Electrical Stimulation Effects

Increase range of motion

Increase muscle strength

Reeducation muscles

Improve muscle tone

Reduces muscle spasm

Control pain

Electrical Stimulation Contraindications

Cardiac disability

Pacemaker

Pregnancy (over abdominal area)

Menstruation

Over cancerous lesions

Over sites of infection

Over exposed metal

Severe obesity

Epilepsy