Modalities are Fun! Sports Med 2

Therapeutic Modalities Guided notes Cryokinetics. Modality: a physical technique or substance administered to produce a therapeutic or pain free affect. Legal concerns Understand use of specific modalities Accurate evaluation of injury Avoid “shotgun” approach Adhere to the law

Cryotherapy most common forms are; ice massages, cold immersion, and ice packs. Physiological effects of cryotherapy: Muscle spasm pain reception blood flow up to 10-15 minutes metabolic rate joint stiffness

Therapeutic effects of cryotherapy: pain or prevent swelling inflammation Minimized secondary tissue damage.

Skin response to cryotherapy: Stage 1 Cold Sensation 0 – 3 min Stage 2 Mild burning, aching 2-7 min Stage 3 Anesthesia 5-12 min

4. Adverse Conditions to Cryotherapy hypothermia frostbite cold allergies Raynauds phenomenon

Contraindications for Cryotherapy lack of normal temperature sensibility cold hypersensitivity Raynaud’s disease Coronary artery disease

Methods p 445… http://youtu.be/9hQsymsi5xU http://youtu.be/ucFQbSbKNJY Ice massage Ice Immersion, CWP Ice Pack Equipment Indications Application Considerations  

Cryokinetics Numb the part to pain free Ice until numb Work toward regaining ROM 3-7 min. Ice until numb Exercise 3-7 min. Ice 3-5 min Repeat 5 times

Thermotherapy is Hot

Thermotherapy: application of heat to treat injuries Thermotherapy: application of heat to treat injuries. Heat energy increases activity by conduction, convection, and radiation. Modes are moist, dry, superficial and deep.

Physiological Effects of thermotherapy: muscle spasm pain perception blood flow metabolic rate collagen elasticity joint stiffness   Therapeutic effects of thermotherapy pain soft tissue extensibility

Adverse Conditions to thermotherapy burns open wounds Contraindications of thermotherapy loss of sensations immediately after injury impaired circulation directly to eyes during acute inflammation

Methods Moist Heat Pack Warm Whirlpool Equipment Hydrocullator packs, 160 degrees. Retain heat for about 20-30min. Terry cloth or towel 98-110 degressF. Heat 10 -20 min Indication Warms and relax, reduction for spasm. Superficial only convection, reduce swelling, spasms, and pain. Applications Remove pack from water, cover, treat Fill tank, put extremity in and heat Considerations Never! Let athlete sit or lay on heat pack…burns Light headedness, electrical outlets, cleanliness

Therapeutic Modalities Electrical stimulation (electrotherapy)

Electrotherapy: implies a flow of electrons between two points. Electricity is a form of energy that displays magnetic, chemical, mechanical, and thermal effects on tissue.   Ampere: volume or amount Ohm: resistance Voltage: force Watt: power. Electrical Stimulating Units: generate 3 different types of currents, which produce specific physiological tissue changes. AC, DC, and pulsed. All 3 send currents through the body. Their purpose is to trigger the peripheral nerves to stop pain.

Examples of Electric generators TENS: transcutaneous nerve stimulators NMES: neuromuscular electrical stimulators EMS: electrical muscle stimulator MENS: micro-current electrical nerve stimulators

Every nerve has an excitability threshold Every nerve has an excitability threshold. This is what we get to play with, with the electrical stem. There are 3 types of nerve fibers: sensory, motor, pain. It is possible to produce different physiologic response by adjusting the treatment parameters.

DC (Majority) AC Pulsed Definition uses Flows in one direction from positive to negative poles Muscle contraction, movement AC Current flow reverses once during each cycle Pain control, muscle contraction Pulsed 3 or more pulses, interrupted for short periods of time Pain control, muscle rehab.

Waveforms: represents electrical current. DC + 0 -

Waveforms: represents electrical current. AC + 0 -

Waveforms: represents electrical current. Pulsed + 0 -

Electrode Set up Electrode Setup: Pads: directly to skin, up to 4 in. Set up in an “X” pattern with the desired stimulation area in the center of the “X”.

Physiological effects of Electrical Stem. depolarization of peripheral nerves   Therapeutic effects of Electrical Stem. stop pain Contraindication of electrical Stem. pregnancy electrical pace devices cardiac arrhythmia

Electrical Stimulation Equipment - Electrotherapy generator Water Pads Towel Indication Pain perception Muscle contraction Strengthening Stop atrophy Muscle re-education Application Spray pads with water Place pads securely Turn on machine Set parameters Have them tell you when they feel something Press start Considerations Same as contraindications

Therapeutic Modalities Ultrasound

Ultrasound: is an inaudible, acoustic sound wave modality used in sport medicine for the purpose of elevating tissue temperature, repairing soft tissues, and relieving pain. Ultrasound can be used for thermal or non-thermal effects on soft tissue.

Physiological Effects of Ultrasound: Thermal: elevated tissue temperature blood flow tissue extensibility local metabolism Non-thermal: cavitation fluid movement cellular permeability

Therapeutic Effects of Ultrasound: collagen tissues extensibility joint stiffness muscle spasm blood flow

Equipment descriptions generator: main piece of equipment for delivering therapeutic ultrasound applicator/ultrasound head: has crystals the rebound the acoustic waves. Piezoelectric effect: causes expansion and contraction of the crystals Effective radiating area: the part where the transducer produces sound waves.

Ultrasound has a frequency range from 1 MHz – 3.3 MHz. 1 MHZ: better if there is a layer of fat, or you need to get to deeper tissue. 3MHz: better for superficial thermal/non-thermal effects

Ultrasound can be continuous or pulsed Energy remains constant 100% of the time Thermal effects Energy is interrupted Non-thermal effects

Method Equipment Ultrasound machine, coupling agent/method: gel, water Indications Soft tissue injury: sprain, strain, contusion. Decrease pain, increase blood flow for repair Applications Put coupling agent on US head Continuous movement of sound head Use firm, steady overlapping motion 2-8 min Considerations Not over large areas Impaired circulation Eyes Spinal cord Not over reproductive organs