1. Ultrasound Ultrasound-therapeutic deep heating that uses high frequency sound waves; also called ultrasonic diathermy. High frequency sound wave(1-3 MHz) Affects tissue up to 5 cm

2. Ultrasound The sound wave is absorbed by high protein tissues such as tendons, ligaments, joint capsules and muscle. A huge amount is absorbed by bone Sound waves travel in a similar manner to waves created by a stone thrown in water.

3. Ultrasound Ultrasound can be done as a continuous mode or a pulsed mode. Pulsed mode- nonthermal effects that will accelerate the healing process, help break up chronic inflammation. Continuous mode- thermal effects that will increase scar mobility, and tissue extensibility, reduce muscle spasm, increase blood flow, and modulate pain.

4. Ultrasound 1 Mega Hertz is used for Deep penetration (5cm) 3 Megahertz is used for Superficial penetration (2 cm) Different types of coupling medium Gel/lotion Water Water balloon

5. Ultrasound Contraindications- Areas of impaired pain, temp sensation, circulation Epiphysis areas of children Reproductive organs Eyes, heart, spinal cord Prostheses Malignancies

6. Ultrasound No more than 14 treatments in a row, then a minimum of a 2 week break. Can be combined with electric stimulation for increase edema control. Sound wave is created by the vibrating synthetic crystal housed in the metal sound head.

7. Phonophoresis Technique in which ultrasound is used to drive a topical medication into the tissue. Greatest advantage is that it is a safe, painless way of delivering a medication for anti-inflammatory purposes. Pulsed ultrasound will be used for nonthermal effects.

8. Paraffin Bath Paraffin provides a superficial heat, with a depth of therapeutic heating of about 1 cm. 2 methods of application; Dip 7-10 times, put in plastic bag, sit for 10 min Dip 1 time, resubmerge for 10 minutes

9. Paraffin Bath Effects: Decrease Pain Increase soft tissue extensibility Vasodilation Specific heating all encompassing Contraindications Lack of normal temp sensibility Over tumors Open wounds

10. Vaporcoolant spray Flori-Methane and ethyl chloride are liquids sprayed on the skin, as their thermal energy are absorbed by the body, superficial cooling results. The sprays are used to treat trigger points and to stretch tight musculotendinous tissue. The spray is used to decrease pain during the treatment.

11. Vaporcoolant Caution- this is a very special modality used for therapuetic cooling. If sprayed for a too long a period in one spot it can cause frostbite or serious damage to tissue.

12. Topical Analgesics Type one Salicylates- inhibit enzyme cyclooxygenase from producing prostagladins which is the messanger in inflammation. So it decreases inflammation.

13. Topical Analgesics Type two Counterirritants- creates abnormal sensation at the skin level that overrides pain impulses. This distracts the central nervous system by overriding the pain signals and decreasing pain.

14. Electrical Stimulation Various types: Interferential/TENS-Pain control Russian/Biphasic-Strengthening Russian/Biofeedback-Reeducation Iontophoresis-edema reduction High Voltage/Russian- Control Muscle Spasm

15. Electrical Stimulation Interferential- crossing of two channels to create a four petaled flower pattern. The treatment is not exact, due to nonhomogeneous body, but generally the stimulation affects the center point strongest. IFC is for pain control, swelling control and to increase mobility.

16. Electrical Stimulation Russian-medium frequency current used for reeducation, strengthening and to decrease muscle spasm. The intensity is high so it is packaged in burst of 50 bursts/sec to make it comfortable. It is an intermittent current, this on/off time varies according to treatment purpose.

17. Electrical Stimulation Russian-Most often used during rehabilitation. The intensity is set to just below intolerable. The patient contracts the muscle as the machine is on, and relaxes when it goes off.

18. Electrical Stimulation Biofeedback-using electronic instruments to measure and give feedback information via auditory or visual signal to help develop voluntary control of a muscle. EMG or Measuring Electric Activity measures the muscles contraction, not the activity. Can be combined with Russian On/off time is similar to Russian, 10/10 is my favorite. Treatment time is from 5-15 minutes

19. Electric Stimulation Iontophoresis-therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current typically used for edema control. Continuous direct current needed, a specific iontophoresis machine. The negative eletrode will push in positive ions, ect. 10 minutes, 3-7 treatments

20. Traction Various Types Mechanical Manual Self Indications Elongation of muscle, ligament and capsular tissue Separation of spinal segments Reduce intradiscal pressure

21. Traction Contraindications Spinal infection Rheumatoid arthritis Osteoporosis Spinal hypermobility Acute-stage injury pregnancy

22. Massage Oldest form of manual therapy for injury. Involves applying mechanical force to various tissues, usually with hands. Too many varieties of massage to mention.

23. Massage Effects Increase in afferent neural input Increase in venous outflow Increase in lymph outflow Decrease in pain Decrease soft tissue swelling and congestion Remodeling of collagen