Therapeutic Modalities

Therapeutic Modalities What are they? Technique that aids healing Important adjunct to therapeutic exercise Why do we use them? Crease optimal environment for injury to heal Limit inflammatory process Break pain-spasm cycle How do you select a modality? Site, type, severity

Therapeutic Modalities Indication Condition that could benefit from a specific modality Contraindication Condition that could be adversely affected from a specific modality

Therapeutic Modalities All about ENERGY Electromagnetic Energy- Electromagnetic spectrum Frequency and Wavelength Inverse relationship between wavelength and frequency Infrared Modalities Cryotherapy Thermotherapy Acoustic Energy Needs medium for transmission Ultrasound Other Massage, traction, medication

Electromagnetic Spectrum Infrared (Thermal Changes) Cold packs Cold whirlpool Hot whirlpool Paraffin Hydrocollator

Transmission Radiation Conduction Convection Conversion Evaporation Heat is transferred through space Laser Conduction Heating or cooling through direct contact Hot or ice pack Convection Heating or cooling indirectly through air or water whirlpool Conversion Heating through other forms of energy ultrasound Evaporation Icey Hot

Cryotherapy

Cryotherapy (cold) Infrared Modality Ice packs Ice massage Cold whirlpool Ice immersion Cold sprays

Cryotherapy Indications Contraindications Acute injuries (24-72 hrs) Pain control Reduction of spasm Contraindications Allergies (Cold uticaria) or Hypersensitivity Uncovered wounds Arthritis

Cryotherapy Transmission of Energy’ Tissue cooling Conduction, convection, evaporation Tissue cooling Temperature dependent Tissue dependent Fat, muscle Time dependent Type of cooling agent (ice vs. water) Limb circumference Ice pack is better than the chemical pack

Physiological Response to Cryotherapy Vasoconstrition of small blood vessels Cooled blood circulates and vasocontriction continues Hunting Response Intermittent period of vasodilation after 15-30 minutes of cold application Lasts for 4-6 minutes Protection form tissue damage- but DOES NOT raise temperature to pre-application levels Causes the redness

Changes Decreases in… Increases in… Blood flow Metabolic rate Inflammation Pain perception Muscle spasm Muscle fatigue Collagen elasticity Increases in… Blood viscosity

Techniques Ice packs Chemical packs Ice massage 20 min Chemical packs 15 min Ice massage 5-10 min Ice immersion/whirlpool 5-20 min Vapocoolant sprays Contrast bath

Stages of Cooling Stage 1: (0-3 min) Stage 2: (2-7 min) Cold sensation Stage 2: (2-7 min) Mild burning and aching Stage 3: (5-12 min Skin anesthesia

Cryokinetics Alternating ice and exercise Anesthesia allows for pain-free exercise

Thermotherapy

Thermotherapy Forms- Superficial and Deep Indications Chronic injuries and pain Muscle spasm/joint stiffness Contraindications Acute injuries Impaired sensations Decreased circulation Impaired thermal regulation

Changes Increases in… Decreases in… Blood flow Metabolic rate Collagen elasticity Capillary permeability Decreases in… Pain perception Muscle spasm Joint stiffness Blood viscosity

Techniques Moist Hot Packs Whirlpools Paraffin Bath Contrast Bath Water temp. 158- 170 degrees 10 min Whirlpools 96-104 degrees 20 min Paraffin Bath 118-126 degrees Dip and soak OR dip and wrap Contrast Bath

Ultrasound Acoustical energy transmitted to tissues via a medium High frequency causes vibrations Just like waves in the ocean

Electrotherapy Indications Contraindications Pain modulation Muscle contraction Contraindications Loss of sensation Over heart, brain, or spinal cord

Massage Mechanical responses Physiological responses Venous and lymphatic drainage Stretching of tissue Physiological responses Increase circulation, metabolism, waste removal Body relaxation Psychological responses Humans respond to being touched

Traction Putting tensions on a body segment Indications Joint hypomobility Muscle spasm Herniated disc Nerve impingement or inflammation Contraindications Unstable bony structures Patient discomfort