Athletic Training Modalities 2 Modalities Thermotherapy Types of
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Athletic Training Modalities 2
Modalities: Thermotherapy • Types of Thermotherapy: – Moist Heat: • Whirlpool Bath – A combination of massage and water immersion – A popular thermotherapy used in sportsmedicine.
Modalities: Thermotherapy – Moist Heat: Whirlpool Bath • Equipment (Tanks) – Extremity • 15”(wide)x 32”(long)x 18”-25” (deep) • Legs and arms – Low-Boy • 24”(wide)x 62”(long)x 18”(deep) • Full body immersion • Lower to the floor – High-Boy • 24”(wide)x 32”-48”(long)x 28” (deep) • Hip or Leg
Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (2) – Equipment (2) • Tank with Turbine Motor – Regulates the air and water movement – Amount of movement (agitation) is controlled by the amount of air is emitted (more air/more water movement) – Turbine can be moved up and down, rotated, or locked in place. – Indications • Provides both conduction (Skin contacting the water) and convection (water swirling around skin)
Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (2) – Indications (2) • • Reduce swelling Reduce muscle spasm Reduce pain Active movement of the body part (buoyancy of water)
Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (3) – Application • Set the Water Temperature – – – Very Cold Tepid Neutral Warm Hot Less than 55 55 -65 80 -90 92 -96 96 -98 98 -104 – Acute Injuries: Very cold-Cold – Chronic Injuries: Tepid-Hot
Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (4) – Applications (2) • • Fill the tank w/water Have athlete get in a comfortable position Place the water jet 8”-10” from the injury Acute injuries: do not to let the water jet hit directly on the injury if it causes pain. • Time: – Acute injuries: no more than 20 minutes – Chronic: 20 -30 minutes
Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (5) – Special Considerations: • Full body immersion may cause dizziness • Care needs to be taken to prevent the spread of infection – Empty tank after each use – Disinfectant (scrub) – Rinse with clean water • Safety – Ground Fault Circuit Interrupters (GFCI) – Athlete is not to turn whirlpool on or off while in the water – Preferred that the on/off switch be away from the whirlpool
Modalities: Thermotherapy • Moist Heat: Paraffin Bath – Equipment • Commercial Paraffin Bath Unit maintains the Paraffin/Mineral Oil mixture at a temperature of 126 -130 degrees. The mineral oil lowers the melting point of the paraffin thus allowing the skin to tolerate the higher temperature w/o burning the skin. • Slats in the bottom to protect the athlete from burns & collect settling dirt. • Paper or plastic bags • Towels
Modalities: Thermotherapy • Moist Heat: Paraffin Bath (2) – Indications • Appling heat to distal extremities • Good for chronic injuries • Angular body parts (hands, wrist, elbows, ankles and feet) – Application • Thoroughly clean (wash) and dry the body part
Modalities: Thermotherapy • Moist Heat: Paraffin Bath (3) – Application (2) • Dip Method – – Dip affected part into the paraffin bath and pull it out Let paraffin harden slightly Repeat 6 -10 times. After the last dip let the wax harden then place in a plastic bag – Wrap toweling around the plastic bag – After finishing the treatment remove the paraffin and place it back into the Paraffin Bath.
Modalities: Thermotherapy • Moist Heat: Paraffin Bath (4) – Application (3) • Soak Method – After dipping the body part into the paraffin bath the athlete leaves it in there for 15 -20 minutes w/o moving it. – After finishing the treatment remove from the paraffin and after the paraffin hardens, place it back into the Paraffin Bath.
Modalities: Thermotherapy • Deep Heat – Therapeutic Ultrasound • The most commonly used deep heat modality in sports medicine • Uses high frequency sound waves beyond the audible range • Heat is produced by conversion type modality • Sound energy causes molecules in the tissue to vibrate and thus producing heat and mechanical energy • Frequency of sound waves: # of oscillations (movements)/second
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (2) – – – Hertz (Hz): 1 Hz = 1 cycle/second 1 k. Hz = 1000 cycles/second 1 m. Hz = 1, 000 cycles/second The human ear can not detect sounds greater than 20, 000 Hz 1 m. Hz is the frequency most commonly used in ultrasound therapy – The amount of tissue penetration that Ultrasound Therapy will penetrate tissue depends on the type of tissue, tissue density, amount of reflection, scattering and absorption. – The greatest heat is produced between the bone and the adjacent soft tissue
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (3) – Equipment: • Therapeutic Ultrasound high frequency generator that produces electricity to the transducer. • The transducer head contains a quartz crystal. Quartz has the property that it can contract and expand. When it contracts and expands it produces the ultrasonic waves. This contraction and expansion is called “piezoeelectrical effect” • The intensity is determined by the amount of energy (electricity) that is delivered to the crystal that is in the sound head. • The intensity is expressed in watts/centimeter squared. • Therapeutic intensities range from 0. 1 -3. 0 w/cm squared.
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (4) – Indications • There are 3 types of therapeutic effects from the application of ultrasound: – Thermal Effects – Mechanical Effects – Chemical Effects
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (4) – Indications: Thermal • Of skin, muscle and fat the greatest heat is created were the bone/muscle meet (106). • Joint Capsule heated as high as 117. 5 • Nerve tissue is 2 x as sensitive to ultrasound than muscle. • Increase Collagen Tissue extensibility (main organic part of connective tissue • Alters blood flow • Changes nerve conductivity • Elevates pain threshold • Raises enzymatic activity • Changes muscle contractibility
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (5) – Indications: Mechanical • Results from mechanical vibrations (micromassage) • This effect only occurs at very low intensities (. 1 -. 2 w/cm squared) – Indications: Chemical • Accelerates enzymatic activity • Increases capillary permeability • Increases ATP activity in skeletal muscle (ATP=Adenosine Triphosphate: found I all cells& when split energy is produced, energy of muscle is stored in this compound)
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (6) – Indications: Other • • Joint contracture Scar tissue Chronic Tendonitis Chronic Bursitis Skeletal muscle spasm Pain Undesirable Calcification – Bursitis, tendonitis, myositis ossificans, exostosis – Helps reabsorption of calcium and/or relieves the inflammation • Planter warts
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (7) – Application – Ultrasound waves can not travel through air. Since the skin can reflect them there must be some type of coupling medium between the sound head and the skin • The mediums may be lotion, water soluble gels or mineral oil. • Clean the skin prior to any treatment • Direct Skin: Must have a medium • Underwater: water is the medium, No air bubbles
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (8) – Combination with other modalities • Hydrocollator Packs • Cryotherapy • Electrotherapy (EGS) – Find trigger points – U. S. increases blood flow while the EGS crates a muscle contraction to help easy the pain/spasm/pain cycle. • Phonophoresis – Method of driving molecules (medication: hyrdocortisone and anesthetic) through the skin by the use of sound waves
Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (9) – Special Considerations • Caution must be taken when used over anesthetized areas (pain is the indicator of over treatment) • Caution must be taken when used over areas that have a decrease in circulation • Do not use over high fluid areas – Eyes, ears, testes, spinal cord, brain or heart • Reproductive organs of females • Acute injuries • Epiphyseal plates: very little exposure
Modalities: Electrotherapy • Physical Principles – Displays: Magnetic, Chemical, Mechanical and Thermal effects on the body – Electrical current: a string of electrons that pass along a conductor or nerve. – Amperes (amps): measures intensity of the current – Ohms: Measures the resistance of the passage of the electrical current – Voltage: the force that moves the current along • Low Voltage: 0 -150 V • High Voltage: above 150 V – Watts (amps x volts): electrical power is measured in
Modalities: Electrotherapy • Physical Principles (2) – 2 types of current used in sports medicine • Alternating Current (AC) – Reverses its self 1 x/cycle – Used for: • pain modulation • Muscle contraction • Direct Current (DC) {or Galvanic} – Current flows in one direction(+ to -) – Used for: • Pain modulation (Gate control, endogenous opiates) • Muscle contraction • Ion movement (iontophoresis: movement of ions through the skin by the use of electrical current)
Modalities: Electrotherapy • Types of Direct Current – Transcutaneous Electrical Nerve Stimulation (TNS or TENS) – Electrogalvanic Muscle Stimulation (EGS) – Electric Muscle Stimulation (EMS)
Modalities: Electrotherapy – Transcutaneous Electrical Nerve Stimulation (TNS or TENS) • Used to block the pain signal between the injury and the spinal cord • Stimulates the nerve
Modalities: Electrotherapy – Electrogalvanic Muscle Stimulation (EGS) • Stimulates the muscle • 150 V or higher to achieve the best results • Can use for: – – – Muscle reeducation Muscle pumping Muscle strengthening Atrophy retardation Iontophoresis
Modalities: Electrotherapy – Electric Muscle Stimulation (EMS) • Stimulates the muscle • 0 -150 V • Can be use for: – – Muscle reeducation Muscle pumping Muscle strengthening Atrophy retardation
Modalities • Other Treatment Modalities – Massage – Acupressure – Traction – Intermittent Compression
Modalities • Massage: – Definition: Systematic manipulation of the body – Types: • • • Effleurage: Petrissage: Friction: Tapotement: Vibration: stroking kneading heat producing percussion rapid shaking
Modalities • Massage (2) – Mechanical: • • Venous drainage Lymphatic drainage Mild stretch of superficial tissue Stretching and breaking up scar tissue – Physiological: • Relaxation • Stimulation of blood flow – Psychological: • Relaxation
Modalities • Massage (3) – Sports Massage • Confined to the specific injury area – Massage Lubricants • Powder, oils, lotions – Confidence • Must be confident in sports massage
Modalities • Acupressure – A type of massage that based on acupuncture
Modalities • Traction – Drawing tension applied to a body segment – Most commonly used on the cervical and lumbar spine regions – Physiological Effects: • • Relief of pressure on nerve roots Decrease pressure on intervertebral disc Relief of compression effects of normal posture Relaxation – Indications: • Relief of spinal nerve impingement • Relief of other nerve impingements
Modalities – Intermittent Compression Devices – Pneumatic sleeve applied around the injured extremity with air or water intermittently applied to the area. • • • Used to control swelling Used to reduce swelling Used on acute or chronic injuries Pitting edema Creates the movement of lymphatic fluid out of the injured area • Extremity should be elevated during treatment
Modalities The End
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