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?Effects

VasoconstrictionReduce 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