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)x32”(long)x18”-25” (deep) Legs and arms –Low-Boy 24”(wide)x62”(long)x18”(deep) Full body immersion Lower to the floor –High-Boy 24”(wide)x32”-48”(long)x28” (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 ColdLess than 55 –Cold55-65 –Tepid80-90 –Neutral92-96 –Warm96-98 –Hot –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: 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 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 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): 1Hz = 1 cycle/second –1kHz = 1000 cycles/second –1mHz = 1,000,000 cycles/second –The human ear can not detect sounds greater than 20,000 Hz –1mHz 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 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 Nerve tissue is 2x 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: 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 1x/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 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: stroking Petrissage: kneading Friction: heat producing Tapotement:percussion Vibration: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