Therapeutic Modalities

1. Therapeutic Modalities

2. Introduction • 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

3. 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

4. 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

5. 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

6. Cryotherapy (Ice) • Physiological effects • Reduced swelling • Decreased nerve conduction velocity • Analgesia- pain decreased

7. Cryotherapy (Ice) • Indications • Acute injuries • After activity • Swelling • Spasm • Pain • Mild burns

8. Cryotherapy (Ice) • Contraindications • Hunting response • Prolonged exposure to cold may lead to superficial vasodilation to protect cold bodypart • Raynaud’s phenomenon • Cold allergy

9. Cryotherapy (Ice) Application • Ice massage • 7-10 minutes • Excellent for muscle spasm and deep soreness

10. 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

11. Thermotherapy (Heat) • Physiological effects • Increased local circulation • Vasodilation • Increased local metabolic rate • Increased collagen extensibility • Increased nerve conduction velocity • Analgesia

12. Thermotherapy (Heat) • Indications • Sub-acute injury • Prior to activity • Reduce spasm/guarding • Contraindications • Acute injury • Impaired sensation

13. 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

14. Thermotherapy (Heat) • Hydrocollator packs • Treat 20 minutes • 150-160 degrees • Will burn! Must pad with layered towels or covers!

15. 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

16. 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

17. Massage • Contraindications • Acute injury (may disturb clotting mechanism) • Fracture sites • Open wounds

18. Types of TherapeuticMassage • Effluerage • Petrissage • Tapotement • Vibration • Cross-friction

19. 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

20. Petrissage • Deeper “kneading” of large muscle masses • Stimulates local circulation • Eliminates muscle trigger points

21. Tapotement • Percussion, cupping, or hacking of the large muscle groups • Typical “health-spa” massage • Invigorates- increases neural response • Increases local circulation

22. 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

23. 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

24. Electrical Stimulation • Many types available • Transcutaneous Electical Nerve Stimulation (TENS) • Useful for pain relief • Portable units are very affordable • Typically treat for 20 minutes

25. 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)

26. 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

27. 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