Why are physical agents and modalities used?
• To reduce or eliminate soft-tissue inflammation
• To speed the healing time of a soft-tissue injury
• To decrease pain
• To modify muscular tone
• To remodel scar tissue
• To increase connective tissue extensibility and length
Thermotherapy is medical therapy with the application of heat. It can
be applied by superficial heating agents such as a hydrocollator pack,
and deep heating agents such as ultrasound or diathermy.
Indications thermotherapy use:
• Joint stiffness
• Musculoskeletal pain and spasm
• Preparation for electrical stimulation and massage
• Subacute, chronic, and traumatic conditions
Contraindication for the use of Thermotherapy:
• Acute injury or inflammation
• Recent or potential hemorrhage
• Thrombophlebitis
• Impaired sensation
• Impaired mentation
• Malignancy
Precautions for the use of Thermotherapy:
• Pregnancy
• Impaired circulation
• Poor thermal regulation
• Edema
• Cardiac problems
• Metal in the area
• Over an open wound
• Over areas where topical counterirritants have been
Hot packs or hot moist packs are canvas bags filled with hydrophilic silicate
They are stored in the hot water hydrocollator
Kept in water at temperatures
of between 165°F and 175°F.
Equipment required:
• Hot pack/hydrocollator
• Towels
• Hot pack covers
• Timer
• bell
1. Remove clothing and jewelry for area and inspect the area.
2. Wrap hot pack in 6-8 layers of dry towels. Hot pack covers can
substitute for 2-3 layers.
3. Apply the wrapped hot pack to the treatment area and secure.
4. Provide patient with bell.
5. After 5 minutes, check on patient and area.
6. After 20 minutes, remove HP and inspect treatment area.
Advantages of Hot Packs:
• Easy to use
• Inexpensive (packs and towels)
• Short use of clinician’s time
• Low level of skill needed for application
• Can be used to cover moderate to large areas
• Readily available for patient purchase and home use
Disadvantages of Hot Packs:
• Must be removed to observe treatment area
• Weight
• May not maintain good contact
• No movement
Adverse effects of Hot packs:
• Burns
• Fainting
• Bleeding
Equipment required:
• Paraffin
• Mineral oil
• Container
• Plastic bags
• towels
1. Remove all jewelry from area to be treated and inspect area.
2. Thoroughly wash and dry area to be treated.
3. Dip hand or foot into the paraffin allowing it to harden some before
dipping again.
4. Redip area 6-10 times.
5. Wrap in plastic bag and then in a towel. May elevate extremity.
6. Leave the paraffin in place for 10-15 minutes or until it cools.
7. When the treatment is complete, peel the paraffin off the hand and inspect
area for any signs of adverse effects and document.
Advantages of using Paraffin treatment:
• Maintains good contact with highly contoured areas
• Easy to use
• Inexpensive
• Body part can be elevated
• Oil lubricates and conditions the skin
• Can be used by the patient at home
• Can be painted on larger areas
Disadvantages of using Paraffin treatment:
• Messy and time consuming to apply
• Cannot be used over an open skin lesion as it
may contaminate the lesion
• Risk of cross-contamination if the paraffin is reused
• Part is dependent position during dipping
Fluidotherapy is a dry heating agent
that transfers heat by convection.
Heated air is circulated through the
particles, suspending and moving them
so that they act like a liquid. The units come in a variety of sizes.
Both the temperature and the amount of particle agitation can
be controlled by the clinician.
1. Remove all jewelry and clothing from the area to be treated and inspect
2. Cover any open wounds with a plastic barrier to prevent the cellulose
particles from becoming lodged in the wound.
3. Extend the body part to be treated through the portal of the unit.
4. Secure the sleeve to prevent particles from escaping from the cabinet.
5. Set the temperature at 100° - 118°F.
6. Adjust the degree of agitation to achieve patient comfort.
7. The patient may move or exercise during the treatment.
8. Treat for 20 minutes.
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• Patient can move during treatment
• Minimal pressure applied to area
• Temp. controlled and constant
• Easy to administer
• Expensive
• Limb in dependent position
• Overheating
• Can be messy
Ultrasound is a deep heating
agent that is used to heat deeper
structures. Deep heating can
increase tissue to a depth of 3-5 cm.
It works by converting sound waves to heat.
Used to treat:
• joint contractures
• muscle spasm
• musculoskeletal pain
• subacute and chronic traumatic and
inflammatory conditions such as osteoarthritis
of the hands (water)
Contraindications for the use of ultrasound:
malignant tumor
central nervous system tissue
joint cement/plastic components
reproductive organs
• acute inflammation
• epiphyseal plates
• fractures
• breast implants
What is cryotherapy?
Cryotherapy or
therapeutic cold means
the removal of heat from
a body part to decrease
cellular metabolism,
improve cellular survival,
decrease inflammation,
decrease pain and
muscular spasm, and
Indications for therapeutic cold:
• acute and chronic traumatic and inflammatory conditions
• edema
• muscle spasm
• musculoskeletal pain
Adverse effects of therapeutic cold:
• tissue death
• frostbite
• nerve damage
• unwanted vasodialation
Sequence of sensations in response
to therapeutic cold:
• intense cold
• burning
• aching
• analgesia and numbness
Equipment required:
• cold pack
• cooling machine
• towels/pillow case
1. Remove jewelry and clothing from area and
inspect area.
2. Wrap cold pack in towel(damp).
3. Position patient comfortably, elevating the
area to be treated id edema is present.
4. Place pack on the area and secure it well.
• easy to use
• inexpensive materials
• short use of clinician’s
• low level of skill required
for application
• covers moderate to
large areas
• can be applied to an
elevated limb
• pack must be removed
to visualize treatment
• patient may not tolerate
weight of pack
Equipment required:
• small cups
• freezer
• towels
• treatment are can
• can use in small and
irregular areas
• short duration
• inexpensive
• can elevate limb
• too time consuming
for large areas
• clinician time
• Remove jewelry and clothing from area and inspect
• Place towels around the area to absorb dripping water
• Rub the ice over the area using small, overlapping circles
• Continue for 5-10 minutes or until patient experiences analgesia at site of
• When treatment is complete, inspect for signs of adverse effects
Vapocoolant Spray:
Uses ice water and compression
at the same time. This application
of cold with compression has been
shown to be more effective than
ice or compression alone in
controlling swelling, pain, and blood
loss after surgery and in assisting
the patient is regaining ROM.
Technique is called “Spray and Stretch.”
It combines rapid cutaneous cooling
with passive stretching to promote
greater elongation of the muscle.
Spray and Stretch technique
Electrotherapy is the therapeutic
use of electricity to transcutaneously
(through the skin) stimulate nerves,
muscles, or both.
In musculoskeletal physical therapy, the indications for electrical stimulation
are the following:
• pain modulation
• decrease muscle spasm
• increase or maintain joint ROM by decreasing joint pain and edema
• increase muscle strength through muscle re-education exercises
• decrease edema
• Neuromuscular ES – used to cause
muscle contraction in order to increase
strength, re-educate the muscle, reduce
spasticity, and stimulate denervated muscle. 
• High voltage pulsed current (HVPC) uses direct current for edema control.
• Transcutaneous electrical nerve stimulation (TENS) –
is designed to provide sensory or motor –like electrical
nerve stimulation for pain management.
• Iontophoresis – the application of a continuous
direct current to transfer medicinal agents
through the skin. 
Hydrotherapy is defined as the
external use of water for treating
physical dysfunction.
Whirlpools and Hubbard Tank –
used for ROM and wound care
Aquatic therapy is used for:
• patient relaxation
• improve circulation
• strengthen muscles
• gait training with decreased
• mobility
Mechanical spinal traction applies a
distraction force to the cervical or lumbar
spine, attempting to separate vertebral
bodies and elongate cervical or lumbar
spinal structures.

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