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Chapter 12. Therapeutic Physical Modalities. Objectives. Upon completion of this chapter, you should be able to: Explain the use and effectiveness of physical modalities Describe the various thermal modalities and their applications. Objectives (cont’d.).

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Chapter 12

Chapter 12

Therapeutic Physical Modalities


  • Upon completion of this chapter, you should be able to:

    • Explain the use and effectiveness of physical modalities

    • Describe the various thermal modalities and their applications

Objectives cont d
Objectives (cont’d.)

  • Upon completion of this chapter, you should be able to (cont’d.):

    • Explain and describe the use of therapeutic ultrasound

    • Explain and describe the use of electrical modalities

Therapeutic physical modalities
Therapeutic Physical Modalities

  • Therapeutic physical modalities

    • Heating, cooling, and mechanical/electrical methods of treatment used on the human body

  • Physical modalities

    • Hot and cold treatments, therapeutic ultrasound, and various electrical modalities

Therapeutic physical modalities cont d
Therapeutic Physical Modalities (cont’d.)

  • Used along with other forms of treatment

    • To relieve pain, reduce or retard swelling, decrease spasm, and promote healing

  • Can minimize time lost from participation

    • Used improperly, condition may worsen

Thermal modalities
Thermal Modalities

  • Cryotherapy

    • Use of cooling agents (e.g., cold packs, cold bucket baths, and ice massage)

    • Most widely used therapy

      • Responses include: reduction of tissue metabolism, decreased nerve conduction velocity, reduced muscle spasm, secondary vasodilatation, and increased in muscle strength

      • If left on too long, counter effects may occur

Thermal modalities cont d
Thermal Modalities (cont’d.)

  • Ice packs

    • Effective for local areas of concern

    • Quick and economical

      • Plastic bags with ice cubes

      • Gel packs

      • Chemical-activated cold pack

Thermal modalities cont d1
Thermal Modalities (cont’d.)

  • Ice massage

    • Used for localized problems (e.g., tennis elbow)

    • Only takes about five minutes

Thermal modalities cont d2
Thermal Modalities (cont’d.)

  • Cold water compression

    • Cold and compression applied simultaneously

Thermal modalities cont d3
Thermal Modalities (cont’d.)

  • Ice baths

    • Immersion in a bucket of ice water

      • Allows complete, uniform coverage

      • Some exercise movements may be performed

Thermal modalities cont d4
Thermal Modalities (cont’d.)

  • Contraindications/precautions

    • Cryotherapy should be used with caution on persons who have:

      • Thermoregulatory problems

      • Sensory deficits

      • Hypersensitivity to cold

      • Impaired circulation

      • Heart disease

      • Malignant tissue

Thermal modalities cont d5
Thermal Modalities (cont’d.)

  • Heating agents

    • Heat is applied superficially (skin deep), or with a modality capable of heating tissues up to a few inches beneath the skin

    • Beneficial effects:

      • Reduced pain

      • Promotion of healing

      • Increased range of motion

      • Muscle relaxation

Thermal modalities cont d6
Thermal Modalities (cont’d.)

  • Heating agents (cont’d.)

    • Localized vigorous heating effects:

      • Substantially increased vasodilatation

      • Increased metabolic rate and capillary pressure and flow

      • Clearance of metabolites

      • Oxygenation of tissue

Thermal modalities cont d7
Thermal Modalities (cont’d.)

  • Hydrocollator packs

    • Moist hot packs used for superficial heating

      • Kept warm in a heated stainless-steel container filled with hot water in the range of 60°C to 90°C

      • Left in place for 10 to 20 minutes contradictions

[Insert Figure 12-6]

Thermal modalities cont d8
Thermal Modalities (cont’d.)

  • Contraindications/precautions

    • ATC must assess the condition and injury status

    • Heat is not used until 48 to 72 hours after injury

    • Heat dilates the vessels and could cause additional bleeding if healing is not adequate

Thermal modalities cont d9
Thermal Modalities (cont’d.)

  • Contraindications/precautions (cont’d.)

    • Heat should not be used:

      • In acute states, with athletes who have impaired circulation, in areas of diminished sensation, or with athletes who may be heat intolerant

Thermal modalities cont d10
Thermal Modalities (cont’d.)

  • Hydrotherapy

    • Superficial heating

      • Agitated, heated water in a whirlpool

    • Larger area on an extremity can be treated

    • Athlete can perform range-of-motion exercises

Thermal modalities cont d11
Thermal Modalities (cont’d.)

  • Contrast therapy

    • Alternating hot and cold water baths for specified time periods

    • May be used in the subacute injury stage (48 to 72 hours after the injury incurs)

Thermal modalities cont d12
Thermal Modalities (cont’d.)

  • Ultrasound

    • Deep-heating modality

    • Not recommended during acute injury stage

Therapeutic electrical modalities
Therapeutic Electrical Modalities

  • Pass electrical currents through skin into the body causing nerve tissue stimulation

    • Use may be limited by law

  • Two main categories:

    • Electrical stimulation

    • Transcutaneous electrical nerve stimulation

Therapeutic electrical modalities cont d
Therapeutic Electrical Modalities (cont’d.)

  • Electrical stimulation therapy

    • Effects include increasing range of motion and muscle strength, reeducating muscles, improving muscle tone, controlling pain, etc.

    • Neuromuscular electrical stimulation is most common

Therapeutic electrical modalities cont d1
Therapeutic Electrical Modalities (cont’d.)

  • Transcutaneous electrical nerve stimulation

    • Commonly applied with a portable unit for pain control

    • Electric current is applied through a surface electrode pad that is in contact with the external skin surface

Therapeutic electrical modalities cont d2
Therapeutic Electrical Modalities (cont’d.)

  • Contraindications

    • Electrical stimulation should not be used:

      • Over the carotid sinus

      • During pregnancy

      • In individuals with pacemakers

      • On people who are sensitive to electricity

      • Any time active motion is contraindicated


  • Appropriate selection and use of physical therapeutic modalities can have a dramatic beneficial effect

    • The wrong selection can have an adverse effect

  • Careful consideration of the nature and stage of the injury is mandatory