Therapeutic Modalities
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Transcript of Therapeutic Modalities
Therapeutic Therapeutic ModalitiesModalities
IntroductionIntroduction
• Therapeutic modalities create an optimal environment for injury repair (DO NOT “CAUSE HEALING”)
• Most common types of modalities – Cryotherapy (cold)– Thermotherapy (heat)– Massage– Electrical stimulation– Therapeutic ultrasound
Physiology Basics
• Vasodilation– Increased size of vascular structures– Means more oxygen to the tissue
• Vasoconstriction– Decreased size of vascular structures– Useful for preserving
compromised/injured cells/tissue
Physiology Basics
• Analgesia– Diminished/reduced sensation
• Metabolic rate– Activity level of cells– Reducing MR can preserve cells damaged
by injury
• Inflammation– Series of events that hinder optimal function
Cryotherapy (Ice)
• Physiological effects– Decreased local metabolic
rate• Important in preventing
secondary hypoxic injury
– Decreased local blood flow
• Vasoconstriction
– Decreased presence of inflammation & the processes of inflammation
Cryotherapy (Ice)
• Physiological effects– Reduced swelling– Decreased nerve
conduction velocity• Analgesia- pain
decreased
Cryotherapy (Ice)
• Indications– Acute injuries– After activity– Swelling – Spasm– Pain– Mild burns
Cryotherapy (Ice)
• Contraindications– Hunting response
• Prolonged exposure to cold may lead to superficial vasodilation to protect cold bodypart
– Raynaud’s phenomenon• Cold allergy
Cryotherapy (Ice)
Application– Ice massage
• 7-10 minutes• Excellent for muscle
spasm and deep soreness
Cryotherapy (Ice)
Application– Ice bags, ice towels, or cold
packs• 15-20 minutes (no longer than
30)• If using packs, be sure to avoid
direct contact to protect skin!
– Cold whirlpool / ice immersion
• 5-15 minutes, 55-65 degrees• Duration and temperature
depends on surface area immersed
Thermotherapy (Heat)
• Physiological effects– Increased local circulation
• Vasodilation
– Increased local metabolic rate– Increased collagen extensibility– Increased nerve conduction velocity– Analgesia
Thermotherapy (Heat)
• Indications– Sub-acute injury– Prior to activity– Reduce spasm/guarding
• Contraindications– Acute injury– Impaired sensation
Thermotherapy (Heat)
• Application– Warm whirlpool
• Treat 15-20 minutes (no longer than 30)• 98-110 degrees
– Contrast baths• Switch back and forth between hot and
cold 3:1 or 4:1 to induce “vascular pumping action” from repeated vasodilation/vasoconstriction
• Particularly useful for troublesome swelling or edema
Thermotherapy (Heat)
– Hydrocollator packs• Treat 20 minutes• 150-160 degrees
– Will burn! Must pad with layered towels or covers!
Thermotherapy (Heat)
– Paraffin bath• Great for angular extremities
(hands & feet)• 125-127 degrees• Wash body part• Dip body part 4-5 times, then
wrap in ice bag and towel• Treat 20-30 minutes• Dispose of wax or return to
bath for re-use• Do not use with open wounds
Massage
• Physiological effects– Increased local blood flow (if done properly)– Increased venous/lymph return– Analgesia & sedative neurological effect
• Indications– Sub-acute injury– Soreness– Persistent swelling
Massage
• Contraindications– Acute injury (may disturb clotting
mechanism)– Fracture sites– Open wounds
Types of Therapeutic Massage
• Effluerage• Petrissage• Tapotement• Vibration• Cross-friction
Effluerage
• Slow, rhythmic, soothing strokes toward the heart
• One hand always in contact w/ patient
• Use massage lotion or cream, gloves optional
• Helps calm/soothe athlete• Encourages venous & lymph return
Petrissage
• Deeper “kneading” of large muscle masses
• Stimulates local circulation• Eliminates muscle trigger points
Tapotement
• Percussion, cupping, or hacking of the large muscle groups
• Typical “health-spa” massage• Invigorates- increases neural
response• Increases local circulation
Vibration
• Rhythmic oscillations of larger muscle groups– Most often quads and hams
• Physiologically speaking, we are not really certain of its effects
• Perhaps largest benefit is psychological
Cross-friction
• Best empirically-supported technique
• Increases local blood flow• Reduces sensation of pain
– Accommodation
• Useful in restoring full function & ROM
• Typical treatment lasts 5 minutes
Electrical Stimulation
• Many types available– Transcutaneous Electical
Nerve Stimulation (TENS)• Useful for pain relief• Portable units are very
affordable• Typically treat for 20 minutes
Electrical Stimulation
• Many types available– Interferential quad polar (IFQP)
• Uses four pads• Good for pain control
– Premodulated Bipolar (PMBP)• Uses two pads• Good for pain control when IFQP
not ideal (small body parts, etc)
Electrical Stimulation
• Other types also available• Settings:
– Higher frequencies tend to produce fast acting, comfortable treatment for acute injuries, while lower frequencies tend to elicit longer lasting relief for chronic injuries
• Typical treatment lasts 15 minutes at intensity of comfort for patient
Therapeutic Ultrasound
• Sound energy which results in deep heating to tissue
• May penetrate up to 3-5 cm when administered a 1 MHz, up to 1-2 cm at 3 MHz.
• Must keep ultrasound head moving to prevent burns
• Typical treatment lasts 5-6 minutes at intensity of 1-1.5 w/cm2