Chapter 12 Therapeutic Physical Modalities Therapeutic Modalities These

Chapter 12: Therapeutic Physical Modalities

Therapeutic Modalities § These are the various heating, cooling, and mechanical/electrical methods of treatment for the human body. § Modalities are used to relieve pain, reduce swelling, decrease spasm, and promote healing Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

Therapeutic Modalities § When used properly they can reduce time lost from participation and shorten recovery time. § Cold and hot modalities are commonly used; cold in acute stages and heat in subacute, healing or chronic stages. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3

Cryotherapy § refers to the use of cooling agents. § Cold decreases feeling by reducing the ability of nerve endings to conduct impulses. § Cooling agents (cold packs, ice buckets, cold whirlpools, and ice massage) are used in the management of pain and edema. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4

Benefits of Cryotherapy § When localized cooling is used: – Initial vasoconstriction occurs – Decrease in nerve conduction velocity – Reduction of muscle spasm – Secondary vasoconstriction – Increase in muscle strength § If left too long, the body may move more blood to the area have a negative effect (inflammation) Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5

Using Cryotherapy § Used for acute injuries § Should be applied following almost all musculoskeletal traumas § Flare-ups of a preexisting condition should be treated with cryotherapy as well. § 20 -30 minutes at a time; 2 hours between applications Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6

Ice Packs § Effectively used for local areas of concern (acute ankle sprain) § Can be made quickly and are economical § Check area for possible adverse reactions § At home and no bags? Use a bag of frozen vegetables or a sandwich bag with ice. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7

Ice Massage § Used for localized problems such as tennis elbow and shin splints § Acceptable forms of use: – Ice cube in a washcloth – Water frozen in a foam or paper cup – Materials purchased from vendors § Advantages: takes less time (5 -7 minutes) and convenient for home use Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

Cold Water Compression § Cold compress therapy utilizes both cold and compression to help alleviate inflammation and swelling. § Systems have been developed to help with this, such as a sleeve containing an internal water bladder § Treatment time is 15 -20 minutes Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9

Ice Baths § Utilized with ice buckets § Cold Whirlpools are also effective § Allows for complete, uniform coverage of the area § Athlete can do movement exercise while in bucket/whirlpool § Treatment time: up to 10 minutes Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Ice Baths § The athlete may feel the following sensations: – Cold : 0 -3 minutes – Burning: 3 -5 minutes – Aching: 5 -8 minutes – Numbness: 8 -10 minutes Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11

Contraindications and Precautions § Use cryotherapy with caution on individuals who have: – Thermoregulatory problems (body does not adjust to temperature) – Sensory deficits – Hypersensitivity to cold – Impaired circulation – Heart disease – Malignant tissue § Monitor reaction to cold § Do not maintain longer than recommended Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12

Heating Agents § Benefits – Reduced pain – Promotion of healing – Increased range of motion – Muscle relaxation § Heating “opens up” the blood vessels (vasodilatation) § Heat should only be utilized after inflammation has subsided. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13

Hydrocollators § Hydrocollators use specifically designed heat packs to administer long-term warmth. § Use with insulated covers and no longer than 20 minutes. § If heat is felt (even with cover) use a towel underneath. § Used for superficial heating Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14

Hydrotherapy § Superficial heating that uses heated water in a specially designed whirlpool § Larger area can be treated § ROM exercise can be performed § Temperature should be between 106 – 110 degrees § Treatment time = 10 -20 min Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15

Contrast Therapy § Alternating hot and cold water baths to the ankle, foot, hand, or elbow. § Can be used in the subacute phase (48 -72 hours after injury) § Helps reduce swelling, pain and increases range of motion. § Various formulas to utilize § EHS – 3 minutes cold, 3 minutes hot (up to 20 min) Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16

Ultrasound § Therapeutic heating that uses highfrequency sound waves. § Not to be confused with ultrasound to image internal body parts § Sound waves enter the body and are absorbed by tissues such as tendons, ligaments, joints, and some muscles. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17

Ultrasound § Ultrasonic beam is created by a sound head or transducer § A cream or gel called a coupling agent must be applied to area - is a medium by which the waves can penetrate the skin § Treatment time : 5 -10 min § Should not be performed on the eyes, heart, uterus, testes, growth plates, fracture sites, artificial joints, or herniated disks § Not recommended during the acute phase! Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18

Electrical Modalities § E-Stim (electrical stimulation) uses electrical impulses to produce muscle contraction. § Used for: – Increasing range of motion – Increasing muscle strength – Reeducating muscles – Improving muscle tone – Enhancing function – Controlling pain – Reducing muscle spasm Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19

TENS § TENS (transcutaneous electrical nerve stimulation) uses electrical impulses to reduce pain by stimulating the sensory pain receptors. § Portable units available § TENS/E-Stim should not be used during pregnancy, on pacemakers, those sensitive to electricity Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20