Therapeutic Modalities Sports Medicine 2 Lexington High School

Purpose Muscle Spasm/Pain Cycle~ injury causes muscle spasms that cause pain that causes muscle spasms Leads to decreased mobility Therapeutic Modalities used to stop cycle Misapplication can make injury worse

Choosing a Modality Is modality safe for this type of injury? Will modality contribute significantly to rehab process and complete recovery? Is person applying modality trained to use it?

Heating and Cooling Means Conduction~ heat transfer by direct contact with another medium. (hot or ice packs) Convection~ heat transfer by indirectly through secondary conductive medium. (air or liquid) Radiation~ heat transfer by or from its source to surrounding environment in form of waves or rays. (ultraviolet light)

Heating and Cooling Means Conversion~ heat transfer that takes place through other forms of energy, such as sound, electricity or chemicals. (Ultrasound, diathermy) Evaporation~ heat transfer takes place when a liquid coverts into a gas. (perspiration)

Thermotherapy Treatments using heat Increase the temperature of the body region to cause vasodilatation Increases blood flow to area Decreases pain and muscle spasms Increasing flexibility to tissues Comforting for most patients

Guidelines for Thermotherapy Never apply to an area of decreased sensation Never apply directly after injury Never apply to eyes or genitalia Never apply to a pregnant belly Never apply over an open wound Do not apply on pts with hx of diabetes

Moist Heat Packs Indications Contraindications Chronic Pain/Tendonitis Lg jt. Contractures Muscle Spasm Chronic edema Pre-heating to electrical stim tx Contraindications Existing fever Cardiac irregularities Decreased skin sensation Infections Active Bleeding Acute inflammatory conditions

Clinical Application Pack should be applied with several layers of towels or hot pack cover Hydrocollator water temp = 170 degrees Treatment time varies as indicated Never lie or sit on hot pack due to increase in burns

Typical Reactions to Hot Pack Feel comfortable warmth Sensation of area relaxing No sensation of burning should be felt

Paraffin Bath Indications Contraindications Chronic Pain Muscle Spasms Chronic Edema Chronic arthritis Soften calloused hands Contraindications Existing fever Infections Hypertension Acute inflammatory injuries Wet hands/fingers Open wounds

Clinical Application and Response ‘Glove hands’ with wax, frequent dip Follow individual manufacturer directions Feel comfortable warmth Feel sensation of relaxation No sensation of burning Feeling of slight oil on hands after removal of wax

Ultrasound High frequency sound wave converted to heat Can reach depths of 3-5 cm Coupling mediums used to help sound waves penetrate the skin Sound head moved in slow, circular pattern with contact at all times

Ultrasound Two Types of Ultrasound Thermal Effects Mechanical Effects ↑ collagen elasticity ↓ Joint stiffness ↓ Pain and spasm ↑ Blood Flow Effects can last up to 1 hour after 5 minute tx. Mechanical Effects ↑ Nerve conduction Cell permeability altered from pressure changes Mineral deposits dissolved Micromassage Protein synthesis promoted

Ultrasound Depths of Ultrasound 1Mhz Frequency: depth of penetration = up to 5 cm 3Mhz Frequency: depth of penetration = 1-2 cm

Ultrasound Intensity (W/cm²) 1 Mhz 3 Mhz 0.5 .04º C .3º C 1 .2º C Ultrasound Rate of Heating per Minute Intensity (W/cm²) 1 Mhz 3 Mhz 0.5 .04º C .3º C 1 .2º C .6º C 1.5 .9º C 2 .4º C 1.4º C

Ultrasound~ Suggested Uses 1Mhz for deep tissue 3Mhz for shallow tissue Treatment time should be 5-10 minutes depending on area being treated Ultrasound treatments not performed more than one time per day

Phonophoresis Combination of ultrasound and medication driven into the skin through sound waves Usually anti-inflammatory medication Time and technique same as regular ultrasound

Cryotherapy Treatments using Cold Decreases tissue temperature Skin Color change from white to red Decrease in total blood flow Decrease in nerve conduction

Cryotherapy Treatment Length Average 15-20 minutes, once an hour Three phases of sensation: Cold sensation lasting 0-3 minutes Mild burning and aching lasting 2-7 minutes Relative numbness lasting 5-12 minutes

Guidelines for Cryotherapy Use of a barrier, except in ice massage Never on anesthetize skin Never on open wounds Never on someone with desensitized skin Monitor for signs of Raynaud’s Phenomenon, condition in which the arteries and arterioles of an extremity constrict extensively. Causes extensive arterial blood flow.

Ice Packs Indications: Contraindications: Acute trauma Acute Pain Heat Illness Muscle Fatigue Spasms Post-op Pain Acute Edema Contraindications: Circulatory insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to cold Raynaud’s Disease

Clinical Application of Ice Pack Directly to injured area Frequency should be 20 minutes for every waking hour in acute injuries No longer than 20 minutes (veins begin to vasodialate to warm body) Used primarily for the first 48-72 hours of an injury

Typical Response to Ice Pack Cold→Burning→Aching→Numbness Numbness takes from 3-7 minutes Treatment usually satisfactory when skin turns pink or red

Ice Massage Indications: Contraindications Acute Trauma Acute Pain Muscle pain/spasm Post-op pain Heat Illness Acute tendonitis Contraindications Circulatory insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to cold Raynaud’s Disease

Clinical Application/ Responses Ice should have round edges Continuous movement of ice to prevent tissue freezing 5-10 minutes, 4-6 times a day Cold→Burning→Aching→Numbness Numbness takes from 3-7 minutes

Cold Whirlpool/Ice Immersion Indications: Acute Trauma Acute Pain Muscle pain/spasm Post-op pain Heat Illness Acute tendonitis Contraindications Circulatory insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to cold Raynaud’s Disease

Clinical Application Frequency of treatment is 20 minutes Cool = 67º - 80º F . . Use for spasticity Cold = 55º - 67º F . . Use for inflammation and acute injury Very Cold = 33º - 55º F . . Use for acute injury and pain relief Encourage athlete to work on ROM while in the whirlpool or cold bath

Typical Reactions Athlete will usually be uncomfortable and not want to do treatment Cold→Burning→Aching→Numbness If water is constantly moving, athlete may never achieve complete numbness

Contrast Bath Theory is that the cold vasoconstricts the veins and the heat vasodialates the veins creating a pumping motion to push edema out of the area Indications and Contraindications same as those for Thermotherapy and Cryotherapy

Clinical Application If swelling is anticipated end in cold Work to ending in hot Hot water should be 95º-110º, and cold water should be 55º-65º Encourage athlete to work on increasing ROM Use a 2:3 ratio of cold to hot or hot to cold Treatment should last between 20 and 30 minutes

Electric Modalities Use of electricity to influence healing by stimulating the body tissues

Guidelines for Electrical Modalities Follow all MD guidelines Explain procedure to the patient Expose and clean area to be treated Place electrodes in appropriate place Use equipment as prescribed Never use on an open wound

Electrical Stimulation Effects: Management of pain through gate control theory Increase in deep blood flow and lymphatic drainage Slight increase in circulation Muscle relaxation

Electrical Stimulation Indications: Pain Edema Spasm Hematoma Trigger Point Early muscle re-education Contraindications: Metabolic diseases Children Pacemaker Tumor Fever Irritated skin

Clinical Application Follow MD recommendations for dosage Treatment time should be 15-20 minutes Each person has different levels that they can tolerate, use the athlete as the guide Athlete should feel a comfortable ‘moving’ tingling zone in the area around the treatment pads

Iontophoresis Use of ions to penetrate medicine into the injured area 1 cm penetration of medicinal ions Numbing effect Advantageous over Injectable: No chance of infection No tissue trauma Medication is only thing going through skin

Iontophoresis Indications: Contraindications: Trigger points Tendonitis Superficial inflammatory conditions Plantar Warts Myositis Bursitis Contraindications: Superficial metal implants Pacemaker Allergy to drug being used Acute injury Anesthetic skin

Clinical Application Must have a prescription for use of medicine Follow MD guidelines for dosage Must use appropriate medicines Athlete should feel some pain relief Athlete should not feel ‘hot pin’ sensation

Diathermy High frequency electrical current to heat the body’s tissue Bigger machines, not popular

Diathermy Indications: Contraindications: Chronic sprains/strains Limited ROM Sub-acute inflammations Contraindications: Acute inflammatory injuries Hemorrhages Casts Metal implants Screws Pregnant women

Clinical Application Sound heads placed around the area being treated Remove all metal from area Cover the area with 2 layers of towels Should feel like a ‘ray of sunshine’ on the skin Heats tissues to 104-112ºF at about 2 inches from skin’s surface