Therapeutic Modalities Introduction Therapeutic modalities create an optimal

Therapeutic Modalities

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Types of Therapeutic Massage • • • Effluerage Petrissage Tapotement Vibration Cross-friction

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

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

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

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

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

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

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)

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

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/cm 2