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 applied 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 Procedure: 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 Caution!!! Adverse effects of Hot packs: • Burns • Fainting • Bleeding Equipment required: • Paraffin • Mineral oil • Container • Plastic bags • towels Procedures: 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. Procedures: 1. Remove all jewelry and clothing from the area to be treated and inspect area. 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. https://www.youtube.com/watch?v=_NAYuPgfgp0 You Tube video Advantages: • Patient can move during treatment • Minimal pressure applied to area • Temp. controlled and constant • Easy to administer Disadvantages: • 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 pregnancy central nervous system tissue joint cement/plastic components pacemaker thrombophlebitis eyes reproductive organs Precautions: • 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 promote vasoconstriction. 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 Procedures: 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. Advantages: • easy to use • inexpensive materials equipment • short use of clinician’s time • low level of skill required for application • covers moderate to large areas • can be applied to an elevated limb Disadvantages: • pack must be removed to visualize treatment area • patient may not tolerate weight of pack Equipment required: • small cups • freezer • towels Advantages: • treatment are can observed • can use in small and irregular areas • short duration • inexpensive • can elevate limb Disadvantages: • too time consuming for large areas • clinician time Procedures: • 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 application • When treatment is complete, inspect for signs of adverse effects Vapocoolant Spray: Cryocuff: 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. https://www.youtube.com/watch?v=krcn2Tn9JHU 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 stress • 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.