Chapter 12: Therapeutic Physical Modalities

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2 Therapeutic Modalities  These are the various heating, cooling, and mechanical/electrical methods of treatment for the human body.  Modalities are used to relieve pain, reduce swelling, decrease spasm, and promote healing

Therapeutic Modalities  When used properly they can reduce time lost from participation and shorten recovery time.  Cold and hot modalities are commonly used; cold in acute stages and heat in subacute, healing or chronic stages. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3

4 Cryotherapy  refers to the use of cooling agents.  Cold decreases feeling by reducing the ability of nerve endings to conduct impulses.  Cooling agents (cold packs, ice buckets, cold whirlpools, and ice massage) are used in the management of pain and edema.

Benefits of Cryotherapy  When localized cooling is used: –Initial vasoconstriction occurs –Decrease in nerve conduction velocity –Reduction of muscle spasm –Secondary vasoconstriction –Increase in muscle strength  If left too long, the body may move more blood to the area have a negative effect (inflammation) Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5

Using Cryotherapy  Used for acute injuries  Should be applied following almost all musculoskeletal traumas  Flare-ups of a preexisting condition should be treated with cryotherapy as well.  minutes at a time; 2 hours between applications Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6

7 Ice Packs  Effectively used for local areas of concern (acute ankle sprain)  Can be made quickly and are economical  Check area for possible adverse reactions  At home and no bags? Use a bag of frozen vegetables or a sandwich bag with ice.

Ice Massage  Used for localized problems such as tennis elbow and shin splints  Acceptable forms of use: –Ice cube in a washcloth –Water frozen in a foam or paper cup –Materials purchased from vendors  Advantages: takes less time (5-7 minutes) and convenient for home use Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

Cold Water Compression  Cold compress therapy utilizes both cold and compression to help alleviate inflammation and swelling.  Systems have been developed to help with this, such as a sleeve containing an internal water bladder  Treatment time is minutes Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9

Ice Baths  Utilized with ice buckets  Cold Whirlpools are also effective  Allows for complete, uniform coverage of the area  Athlete can do movement exercise while in bucket/whirlpool  Treatment time: up to 10 minutes Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Ice Baths  The athlete may feel the following sensations: –Cold : 0-3 minutes –Burning: 3-5 minutes –Aching: 5-8 minutes –Numbness: 8-10 minutes Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11

Contraindications and Precautions  Use cryotherapy with caution on individuals who have: –Thermoregulatory problems (body does not adjust to temperature) –Sensory deficits –Hypersensitivity to cold –Impaired circulation –Heart disease –Malignant tissue  Monitor reaction to cold  Do not maintain longer than recommended Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12

Heating Agents  Benefits –Reduced pain –Promotion of healing –Increased range of motion –Muscle relaxation  Heating “opens up” the blood vessels (vasodilatation)  Heat should only be utilized after inflammation has subsided. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14 Hydrocollators  Hydrocollators use specifically designed heat packs to administer long-term warmth.  Use with insulated covers and no longer than 20 minutes.  If heat is felt (even with cover) use a towel underneath.  Used for superficial heating

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15 Hydrotherapy  Superficial heating that uses heated water in a specially designed whirlpool  Larger area can be treated  ROM exercise can be performed  Temperature should be between 106 – 110 degrees  Treatment time = min

Contrast Therapy  Alternating hot and cold water baths to the ankle, foot, hand, or elbow.  Can be used in the subacute phase (48-72 hours after injury)  Helps reduce swelling, pain and increases range of motion.  Various formulas to utilize  EHS – 3 minutes cold, 3 minutes hot (up to 20 min) Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16

Ultrasound  Therapeutic heating that uses high- frequency sound waves.  Not to be confused with ultrasound to image internal body parts  Sound waves enter the body and are absorbed by tissues such as tendons, ligaments, joints, and some muscles. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18 Ultrasound  Ultrasonic beam is created by a sound head or transducer  A cream or gel called a coupling agent must be applied to area - is a medium by which the waves can penetrate the skin  Treatment time : 5-10 min  Should not be performed on the eyes, heart, uterus, testes, growth plates, fracture sites, artificial joints, or herniated disks  Not recommended during the acute phase!

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19 Electrical Modalities  E-Stim (electrical stimulation) uses electrical impulses to produce muscle contraction.  Used for: –Increasing range of motion –Increasing muscle strength –Reeducating muscles –Improving muscle tone –Enhancing function –Controlling pain –Reducing muscle spasm

TENS  TENS (transcutaneous electrical nerve stimulation) uses electrical impulses to reduce pain by stimulating the sensory pain receptors.  Portable units available  TENS/E-Stim should not be used during pregnancy, on pacemakers, those sensitive to electricity Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20