Chapter 1. Therapeutic Modalities: What They Are and Why They Are Used
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Chapter 1. Therapeutic Modalities: What They Are and Why They Are Used. Working Hard Is Important. Working Smart Is More Important. What Are Therapeutic Modalities?. No text or dictionary has yet to define them. Therapeutic. Taber’s Cyclopedic Dictionary (1997;19:1934).

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Chapter 1. Therapeutic Modalities: What They Are and Why They Are Used

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Chapter 1. Therapeutic Modalities: What They Are and Why They Are Used

Working Hard Is Important

Working Smart Is More Important

What Are Therapeutic Modalities?

No text or dictionary has yet to define them.


Taber’s Cyclopedic Dictionary (1997;19:1934)

  • Pertains to results obtained from treatment

  • Having medical or healing properties

  • A healing agent


Taber’s Cyclopedic Dictionary (1997;19:1222)

  • A method of application or the employment of any therapeutic agent

  • Limited usually to physical agents and devices

  • Any specific sensory stimulus such as taste, touch, vision, pressure, or hearing

Put It All Together

  • Therapeutic modality:

  • A device or technique that delivers a physical agent to the body for therapeutic purposes

Physical Agents

  • Heat

  • Cold

  • Light

  • Electricity

  • Exercise

What Therapeutic Purpose?

To promote:

  • Wound healing

  • Pain relief

  • Flexibility and range of motion

  • Muscular strength

  • Muscular endurance

What Therapeutic Purpose? (cont.)

To promote (cont.):

Muscular speed

Muscular coordination or skill



Cardiorespiratory endurance

Classification of Therapeutic Modalities

  • Therapeutic modalities have been classified in many different ways.

  • But each is incomplete—that is,

  • none includes all modalities.

Classification of Therapeutic Modalities (cont.)

  • Mechanical: massage, mobilization, US, whirlpool

  • Cryotherapy: ice pack, immersion, ice massage

  • Thermotherapy: moist heat, dry heat, diathermy, US

  • Hydrotherapy: whirlpool, contrast bath, aquatic pool

  • Electrotherapy: muscle stimulation, TENS, diathermy

  • Active exercise

Selecting Which Therapeutic Modality to Use

  • Do you select?

  • Or does a physician select?

An ISU Physician’s Prescription

  • Physical therapy for _____ because of pain and swelling of the left ankle and foot.

Brockport Team Physician

  • Often prescribed diathermy,

  • but we didn’t have a diathermy machine

  • Sometimes PTs work with physiatrists, who are specialists in physical medicine and rehabilitation.

  • They will usually get good prescriptions, but most PTs and ATs usually don’t get good prescriptions.

  • Need to educate the physicianabout what the AT is using

To Select Modality(ies) Intelligently

You must:

  • Have a correct diagnosis

  • Have a definite conception of the pathological and physiological changes associated with the injury

To Select Modality(ies) Intelligently (cont.)

  • Know what you want to accomplish with the modality—that is, have a therapeutic goal

  • Understand the modalities effects, indications, and contraindications

  • Match your therapeutic goal with a modality that will help you achieve that goal


The study of application without theory

Art vs Science Theory vs Application

Rehabilitation and Therapeutic Modalities

  • To fully understand the role of therapeutic modalities you must:

    • Understand the overall rehabilitation process

    • Understand how each therapeutic modality fits into that process

  • See theBIGPicture

What Modality Is Used When?

  • With a systems approach, you must have a basis for choosing which therapeutic modality to use during various phases of rehabilitation.

  • Must match theproper therapeutic modality with the therapeutic goal.

Efficacy of Modalities

Rate modalities for effect during rehabilitation.

  • Direct effect (good choice)

  • Effective if used in a specific way

  • Somewhat effective; not the best choice; there are better modalities for developing this element of rehabilitation

Modality Efficacy: Summary

  • Traditional modalities (heat, light, sound, electricity) are used during only the first three phases.

  • Exercise is needed for most phases of rehabilitation.


  • Therapeutic exercise is not covered in this class, except for cryokinetics and cryostretch.

What Rehabilitation Is Not

  • Treat then rehabilitate

  • Working with weights

  • A cookbook approach

Treat Then Rehabilitate

  • Treat with various therapeutic modalities (e.g., whirlpool, ultrasound) and then “rehabilitate”

    • Rehabilitation = the entire process of returning an injured athlete to competition

Working with Weights

  • Concept too narrow

    • Rehabilitation = the entire process of returning an injured athlete to competition

    • Much more than strength training

A Cookbook Approach

  • Stages or phases established with specific time periods and exercises

  • Optimal rehabilitation not planned by the calendar or by specific exercises

Re habilita tion

  • Reagain, anew, restore

  • habilitate to make suitable

  • habitcharacteristic condition of mind or body

  • tion the act of


  • To restore to a normal or optimal state of health

    • For an athlete, to a high level of conditioning

  • Process of returning an athlete to a high level of conditioning

Rehabilitation (cont.)

  • More than progressing through various phases of conditioning

  • For optimal results, rehabilitation must be planned and the plan executed systematically.

Rehabilitation (cont.)

  • For optimal results, you must consider:

    • Timing

    • Goals

    • Rate of progression

    • Criteria for progression

    • Psychological factors

Systems Approach to Total Rehabilitation

  • Each patient and each injury is unique.

    • Based on signs, symptoms, and needs

      • Identify each phase of rehabilitation.

      • Establish criteria for developing each phase.

      • Carefully analyze the limitations imposed by the injury.

      • Determine which phase of rehabilitation to begin with.

Ten Elements of Rehabilitation

  • 1. Structural integrity

  • 2. Pain-free joints and muscles

  • 3. Joint flexibility

  • 4. Muscular strength

  • 5. Muscular endurance

Ten Elements of Rehabilitation (cont.)

  • 6. Muscular speed

  • 7. Muscular power (strength and speed)

  • 8. Skill patterns (integrated and coordinated movement 9. Agility (speed and skill)

  • 10. Cardiovascular endurance

Rehabilitation Principles

  • The SAID principle

  • Therapeutic goals

  • Constant evaluation

  • Functional progression

  • Early exercise essential

  • Rate of reconditioning

  • Begin early, end late

The SAID Principle

  • Specific adaptation to imposed demands

  • dominates rehabilitation.

  • The body responds to a given demand witha specific and predictable adaptation.

  • Specific adaptation requires that specific demands be imposed.

The SAID Principle (cont.)

  • Each physical attribute must be identified and specifically trained for.

  • Optimize by using a goal-oriented approach.

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