Therapeutic Modalities - College of the Siskiyous

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Therapeutic Modalities
Chapter 6 or 7
Therapeutic Modalities
 Indication:
A condition that could benefit from a
specific modality.
 Contraindication:
A condition that could be
adversely affected if a particular modality is used.
Electromagnetic Spectrum
 Electromagnetic
Radiation
 Electromagnetic Spectrum
 Ionizing
Range
 Non-Ionizing Range
Ionizing Range
 Energy
readily alters the components of atoms.
 Used for X-rays and Treating Cancer.
 Not used by Athletic Trainers
Non-Ionizing Range
 Ultraviolet-
Superficial tissue treatment
 Infrared Near
Infrared- 5-10mm deep
 Far Infrared- <2mm deep
 Diathermy-
Conversion
Transfer of Energy
 Energy
moves from an area of HIGH concentration
to an area of LOW concentration.
 Radiation
 Conduction
 Convection
 Conversion
 Evaporation
Radiation
 When
the surrounding environment is hotter that
the body the radiant heat is absorbed. No-contact
is made.
 Short-wave Diathermy
 Microwave Diathermy
Conduction
 Direct
transfer of energy between two objects in
physical contact with each other. Energy is
transferred from the area of high temp. to the area
of low temp.
 Ice packs
 Moist heat packs
 Paraffin
Convection
 Much
like conduction, but the medium moves
across the body causing variations.
 Fluidotherapy
 Whirlpools
Conversion
 Changes
other energy forms into Heat.
 Ultrasound
 Microwave
 Liniments or Balms
Evaporation
 Heat
is absorbed by the liquid on the skins surface
and cools the skin as it turns into a gaseous state.
 Vapocoolant sprays
 Alcohol
Factors Affecting Transfer of Energy
 Density
of Medium
 Reflection
 Refraction
 Absorption
 Law of Grotthus-Draper
Energy’s Effect on Tissue
 Cosine
law +/- 10ºF is acceptable
 Inverse Square Law E=Es/D²
 E=
Resulting Energy
 Es= Source Energy
 D= Distance Squared
Cryotherapy
Heat Abstraction
 Depth of 5cm can be
cooled
 Change in Temperature
depends on:

Type of Agent
 Temp. difference between
agent and tissue
 Amount of insulation




Thermal Conductivity
Limb circumference
Duration of application
Cryotherapy
 Leads
to vasoconstriction
 Decreases tissue metabolism
 Decreases tissue permeability
 Decreases capillary permeability
 Decreases pain
 Decreases spasms
 Analgesic relief of pain
Cryotherapy
 Ideal Temperature
32-65°F
 20-30 mins. (10-15 mins.) of treatment
 30+ mins. If a towel is used
 90 mins. Is the bodies rewarming period
 Four progressive sensations
 Cold
Burning
Aching
Analgesia
Types of Cryotherapy Applications
 Cryokinetics
 Ice
Massage
 Ice Packs
 Cryocuffs
 Ice Immersion (Whirlpool)
 Contrast Bath
 Commercial Gel and Chemical Packs
Types of Cryotherapy Applications
cont.
 Controlled
Cold-Compression Units
 Vapocoolant sprays
Cryotherapy
 Indications
 Acute
or chronic pain, or muscle spasm
 Acute inflammation
 Post surgical pain or edema
 Superficial first-degree burns
 Facilitate mobilization
 Relieve Pain
 Decrease Muscle spasiticity
Cryotherapy

Contraindications
Hypersensitivity
 Cold Allergy
 Circulatory or sensory impairment
 Reynaud’s disease
 Hypertension
 Open wounds
 Cardiac or respiratory disorders
 Nerve palsy
 Arthritis

Thermotherapy
 Increases
circulation
 Increases cellular metabolism
 Produces analgesic or sedative effect
 Helps resolve pain and muscle spasming
 Vasodilatation:
 Promotes
Healing
 Increases Oxygen concentration
 Removes debris and waste products
Thermotherapy

Modes of use
Conduction
 Convection
 Radiation


Types of Applications
Whirlpools
 Hot tubs
 Jacuzzis
 Moist heat packs

Paraffin baths
 Ultrasound
 Phonophoresis
 Diathermy heat

Ultrasound

Indications
Increase deep tissue heat
 Decrease inflammation
 Decrease muscle spasms
 Decrease pain
 Increase extensibility of
collagen tissue
 Decrease pain of neuromas
 Decrease joint adhesions
 Treat myositis ossificans


Contraindications








Hemorrhage
Infection
Thrombophlebitis
Suspected malignancy
Impaired circulation or sensation
Stress fracture sites
Epiphyseal growth plates
Over the Eyes, Heart, Spine, or
genitals
Ultrasound
 Thermal
effects
 Non-thermal effects
 Application of Ultrasound
 1MHz
3-5cm of penetration
 3MHz superficial tissues and tendons
 Continuous-
100%
 Pulsed- 10-50%
Phonophoresis
 Ultrasound
with drugs, used to increase absorption
and penetration of drugs up to 5 or 6 cms
 Anti-inflammatory’s
 Cortisol
 Dexamethasone
 Salicylates
 Analgesics
 Lidocaine
Electrotherapy
 Decrease
pain
 Increase blood flow
 Increase Range of Motion
 Increase muscle strength
 Muscle re-education
 Facilitate absorption of medicines
Electricity
 Flows
between two points
 DC- Direct-current
 Continuous
one directional flow
 Used for pain modulation or muscular contraction also
produce ion movement
 AC- Alternating-current
 Continuous
two directional flow of ions
 Used for pain modulation or muscular contraction
Electrotherapy
Amplitude
 Frequency
 Pulse duration
 Pulse charge
 Electrode set-up
 Polarity
 Mode

Duty cycle
 Duration of Treatment

Electrotherapy
TENS (transcutaneous
Electrical Nerve
Stimulation)
 High-Voltage pulsed
stimulation
 Neuromuscular Electrical
Stimulation
 Interferential stimulation

Low-Intensity Stimulation
 Galvanic Stimulation
 Russian current
 Faradic current
 Iontophoresis

Massage
 Effleurage
 Petrissage
 Tapotement
 Vibration
 Friction
Traction

Indications









Herniated disc
Spinal nerve impingement
Spinal nerve inflammation
Joint hypo-mobility
Narrowing of intervertebral
foramen
Degenerative joint disease
Spondylolisthesis
Muscle spasm and guarding
Joint pain

Contraindications
Unstable vertebrae
 Acute lumbage
 Gross emphysema
 S4 nerve root signs
 Temperomandibular joint
dysfunction
 Patient discomfort

Drugs
 Anti-inflammatory
 Anti-pyretic
 Analgesics
(NSAIDS)

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