The Science of Therapeutic Modalities

Legal Considerations Athletic Trainers vs. Physical Therapists Chiropractors

When Do You Use Therapeutic Modalities? For First Aid Immediately Following Injury Throughout The Injury Rehabilitation Process

Choices Athletic Trainers Have A Choice Of A Variety of Therapeutic Techniques Most All Athletic Trainers Eventually Choose To Use Therapeutic Modalities How You Choose To Use A Therapeutic Modality Is An Individual Decision The Choice Must Be Based On Theoretical Knowledge And Practical Experience

Regardless of Choice Remember….. When Using a Therapeutic Modality In Rehabilitation It Should Be Used ONLY As An Adjunct To Other Forms Of Therapeutic Exercise

How Do We Classify Modalities? Therapeutic Modalities Used By Athletic Trainers Can Be Classified As Being…. Electromagnetic Acoustic Mechanical

Radiation Process By Which Energy In Various Forms Travels Through Space Sunlight Is A Form Of Radiant Energy Many Modalities Produce Radiant Energy

Spectrum Red Orange Yellow Green Blue Violet Prism

Electromagnetic Radiations Other Forms Of Radiation Other Than Visible Light May Be Produced When An Electrical Force Is Applied

Infrared Spectrum Red Orange Yellow Green Blue Violet Ultraviolet

Electromagnetic Radiations In Addition, Other Forms Of Radiation Beyond Infrared And Ultraviolet Regions May Be Produced When An Electrical Force Is Applied These Radiations Have Different Wavelengths And Frequencies Than Those In The Visible Light Spectrum

Collectively The Various Types Of Radiation Form The Electromagnetic Spectrum

{ Electromagnetic Spectrum Electrical Stimulating Currents Longest Wavelength Lowest Frequency Electrical Stimulating Currents Commercial Radio and Television Shortwave Diathermy Microwave Diathermy Infrared { LASER Visible Light Ultraviolet Shortest Wavelength Highest Frequency Ionizing Radiation

Wavelength And Frequency Wavelength-Distance Between Peak Of One Wave and Peak of the Next Wave Frequency-Number Of Wave Oscillations Or Vibrations Per Second (Hz, CPS, PPS) Velocity=Wavelngth X Frequency

Electromagnetic Radiations Share Similar Physical Characteristics Produced When Sufficient Electrical Or Chemical Forces Are Applied To Any Material Travel Readily Through Space At An Equal Velocity (300,000,000 meters/sec) Direction Of Travel Is Always In A Straight Line

Electromagnetic Radiations Share Similar Physical Characteristics When Contacting Biological Tissues May Be…

Electromagnetic Radiations Share Similar Physical Characteristics When Contacting Biological Tissues May Be… Reflected

Electromagnetic Radiations Share Similar Physical Characteristics When Contacting Biological Tissues May Be… Reflected Transmitted

Electromagnetic Radiations Share Similar Physical Characteristics When Contacting Biological Tissues May Be… Reflected Transmitted Refracted

Electromagnetic Radiations Share Similar Physical Characteristics When Contacting Biological Tissues May Be… Reflected Transmitted Refracted Absorbed

Laws Governing The Effects of Electromagnetic Radiations Arndt-Schultz Principle No Changes Or Reactions Can Occur In The Tissues Unless The Amount Of Energy Absorbed Is Sufficient To Stimulate The Absorbing Tissues

Laws Governing The Effects of Electromagnetic Radiations Law Of Grotthus-Draper If The Energy Is Not Absorbed It Must Be Transmitted To The Deeper Tissues The Greater The Amount Absorbed The Less Transmitted and Thus The Less Penetration

Laws Governing The Effects of Electromagnetic Radiations Cosine Law The Smaller The Angle Between The Propagating Radiation And The Right Angle, The Less Radiation Reflected And The Greater The Absorption Source Source

Laws Governing The Effects of Electromagnetic Radiations Inverse Square Law The Intensity Of The Radiation Striking A Surface Varies Inversely With The Square Of The Distance From The Source Source 1 Inch 2 Inch

Electromagnetic Modalities The Majority of Therapeutic Modalities Used By Athletic Trainers Emit A Type Of Energy With Wavelengths And Frequencies That Can Be Classified As Electromagnetic Radiations

Electromagnetic Modalities Include... Electrical Stimulating Currents Shortwave And Microwave Diathermy Infrared Modalities Thermotherapy Cryotherapy Ultraviolet Radiation Therapy Low-Power Lasers Magnet Therapy

Electrical Stimulating Currents

Electrical Stimulating Currents All Can Be Classified As Transcutaneous Electrical Stimulating Currents Electrical Muscle Stimulators (EMS) Transcutaneous Electrical Nerve Stimulators (TENS) Low Intensity Stimulators (LIS / MENS)

Electrical Stimulating Currents Russian Currents Interferential Currents

Electrical Stimulating Currents Russian Currents Interferential Currents Low-Volt Currents (Iontophoresis)

Electrical Stimulating Currents Used Primarily For Pain Modulation Muscle Contraction To Create Ion Movement

What Can Electrical Stimulating Currents Be Used For? Pain Modulation Stimulation of sensory cutaneous nerves (Gate Control) at high frequency i.e. TENS Production of B-endorphins at lower frequency i.e. Electroacutherapy

What Can Electrical Stimulating Currents Be Used For? Producing Muscle Contraction, Relaxation, And Tetany Depends On Type Of Current Alternating (AC) Direct (DC) Polyphasic (Interferential) Depends On Frequency (Russian Currents)

Therapeutic Uses Of Electrically Induced Muscle Contraction Muscle Re-education Biofeedback Uses Surface EMG To Measure, Process, And Feedback Reinforcing Information Via Auditory Or Visual Signals Helps Athlete Develop Greater Voluntary Control In Terms Of Either Neuromuscular Relaxation Or Muscle Re-education

Therapeutic Uses Of Electrically Induced Muscle Contraction Muscle Re-education Muscle Pumping Contractions To Reduce Edema Retardation Of Atrophy Muscle Strengthening Increasing Range Of Motion

What Can Electrical Stimulating Currents Be Used For? Facilitating Soft Tissue And Bone Healing Through Biostimulative Effects Subsensory Microamperage Currents (LIS)

What Can Electrical Stimulating Currents Be Used For? Producing a Net Movement Of Ions Through The Use Of Continuous Low-voltage Currents That Elicit A Chemical Change In The Tissues (Iontophoresis)

Shortwave And Microwave Diathermy

Diathermy High Frequency Electromagnetic Energy Cannot Depolarize Nerve or Muscle Both SWD and MWD Used Primarily To Generate Heat In The Tissues SWD Also Used For Nonthermal Effects

Shortwave Diathermy Generators Induce Magnetic And/Or Electrical Fields May Be Either Continuous Or Pulsed Continuous SWD Produces High Frequency Vibration Of Molecules In Tissues Generating Heat Pulsed SWD Causes Repolarization In Damaged Cells Correcting Dysfunction

When Should Diathermy Be Used? If The Skin Or Some Underlying Soft Tissue Is Tender And Will Not Tolerate Pressure In Areas Where Subcutaneous Fat Is Thick And Deep Heating Is Required Pulsed SWD Produces The Same Magnitude And Depth Of Muscle Heating as 1MHz Ultrasound (Draper, JAT 1997) When The Treatment Goal Is To Increase Tissue Temperatures In A Large Area

Infrared Modalities Cold = Cryotherapy Heat = Thermotherapy

Cryotherapy

What Should Cryotherapy Be Used For? To Decrease Local Temperature To Decrease Local Metabolism To Decrease Blood Flow (Vasoconstriction) To Decrease Venous And Lymphatic Flow To Decrease Nerve Conduction Velocity To Decrease Muscle Excitability Analgesia

Cryotherapy Techniques Ice Bags or Ice Packs

Cryotherapy Techniques Ice Bags or Ice Packs Ice Massage

Cryotherapy Techniques Ice Bags or Ice Packs Ice Massage Fluori-methane (Spray and Stretch)

Cryotherapy Techniques Ice Bags or Ice Packs Ice Massage Fluori-methane (Spray and Stretch) Contrast Bath

Thermotherapy

What Should Thermotherapy Be Used For? To Increase Local Temperature To Increase Local Metabolism To Increase Blood Flow (Vasodilation) To Increase Venous And Lymphatic Drainage To Increase Elasticity of Muscles & Ligaments To Increase Nerve Conduction Velocity To Increase Muscle Excitability Analgesia

Thermotherapy Techniques Hydrocollator Packs

Thermotherapy Techniques Hydrocollator Packs Whirlpools

Thermotherapy Techniques Hydrocollator Packs Whirlpools Paraffin Baths

Thermotherapy Techniques Hydrocollator Packs Whirlpools Paraffin Baths Fluidotherapy

Ultraviolet Light Therapy

What Can Ultraviolet Therapy Be Used For? Causes Chemical Changes In Skin That Have A Bactericidal Effect Effects Are Primarily Superficial In Nature (<2mm) To Treat A Variety Of Skin Lesions Including Acne, Folliculitis, Pityriasis, Tinea, Septic Wounds Seldom Used In Treatment Because Of Availability Of Topical Agents

LASER Therapy

What Are Low-Power Lasers Used For? Helium-Neon (HeNe) & Gallium-Arsenide (GaAs) Produces No Thermal Effects Soft-tissue And Fracture Healing Pain Management Not Approved By FDA For Therapeutic Use

Magnet Therapy

Magnet Therapy Despite Popularity No One Really Knows How They Work!! Generally Thought To Be Safe

What Are Magnets Used For? Pain Modulation Facilitate Strength Explanations Increased Circulation Increased Temperature Changes In pH Reestablishing Normal Polarity Within The Injured Cell

Therapeutic Ultrasound

Unlike Other Modalities Ultrasound Is Acoustic Energy

Ultrasound Frequently Classified With Diathermy As A “Deep Heating” Modality Mechanical Vibration Sound Wave Trans-formed From High Frequency Electrical Energy

Acoustic Energy Cannot Travel Through Space Relies On Molecular Collision For Transmission More Dense Medium = Higher Velocity Of Travel Depth Of Penetration Greater Than Any Form Of Electromagnetic Energy

What Should Ultrasound Be Used For? Thermal Effects Particularly In Deeper Tissues Non-Thermal Effects To Enhance Healing At Cellular Level

Mechanical Modalities

Intermittent Compression

Intermittent Compression Mechanical Units That Create External Pressure Facilitates Venous And Lymphatic Reabsorbtion Of Edema Helps Decrease Pain & Increase ROM

Traction

What Should Traction Be Used For? To Treat A Variety Of Cervical And Lumbar Spine Problems Creates Separation Of Vertebrae Alters Proprioceptive Discharge Of Spine Stretches Connective Tissue Stretches Muscle Improves Blood And Lymphatic Flow Decreases Pressure On Disk

Traction Techniques Manual Traction

Traction Techniques Manual Traction Traction Machines

Traction Techniques Manual Traction Traction Machines Wall-Mounted Traction

Traction Techniques Manual Traction Traction Machines Wall-Mounted Traction Inversion Traction

Massage Techniques

Massage Many Massage Techniques Hoffa Massage Acupressure/Shiatsu Connective Tissue Myofascial Release Rolfing Trager

What Should Massage Be Used For? Massage Has Effects On: Circulation And Lymphatic Flow Nervous System Muscles Myofascia Skin Scar Tissue Psychological Responses Relaxation Pain