1. Introduction to Therapeutic Modalities 14 May 20151

2. Today’s Topic Introduce the inflammatory response (the physiological effect of injury) The role of therapeutic modalities in the treatment of athletic injuries 14 May 20152

3. Inflammatory Response Definition: - protective response of tissues of body to irritation or injury Causes of inflammation: - foreign body, physical trauma, electrical energy, temperature extremes 14 May 20153

4. Process of Inflammation Transient vasoconstriction then tissue bleeding Release of chemical mediators (bind to plug) - histamines & bradykinins - causes swelling and isolates the area - pressure on nerve endings Clot formed  WBC activate endothelial cells - phagocytosis (destroy bacteria and engulf dead cells) 14 May 20154

5. Inflammatory response Phagocytes die Collection of dead tissue forms 14 May 20155

6. Inflammation 14 May 20156 PAIN SPASM

7. Treatment Goals Break the P-S cycle Control pain!!! Minimize extent (edema/effusion) Minimize secondary tissue damage 14 May 20157

8. Tissue Healing Removal/minimize waste O 2 and nutrients to tissues 14 May 20158

9. Initial Treatment Cold….. Effects of cold 14 May 20159

10. Txt - 1st 24 - 72 hours Use of cold (cryotherapy) 1. Decreases bleeding in tissues 2. Slows/decreases nerve impulses 3. Decreases mm spindle action 4. Decreases demand for O 2 5. Decreases 2° tissue damage 14 May 201510

11. Properties of Cold 14 May 201511 ANALGESIC & ANESTHETIC

12. Principles of Treatment & Rehabilitation 1st 72 hours: follow basic protocols P: protect R: rest injured tissue/modify activity I: apply ice to area 20-30 min/hr C: compression wraps E: elevation encourage active, pain free ROM 14 May 201512

13. Principles of Treatment & Rehabilitation Beginning on day 3??? 1. Other modalities 2. Exercise programs 3. Manual therapy 14 May 201513

14. Objectives of Treatment & Rehabilitation Assist healing Regain length & strength of injured tissue Regain function: 1. CV fitness 2. Endurance 3. Speed 4. Psychomotor skills 14 May 201514

15. Healing & Recovery Times Muscle: 6 weeks Tendon & ligaments: 12 weeks - some (ACL) 8-12 months Bone & joints: 6-12 weeks 14 May 201515

16. Modality Intervention Limit pain-spasm cycle Minimize inflammatory response Enhance healing Allows better tolerance to rehabilitation 14 May 201516

17. Categories of Modalities Cryotherapy Superficial thermotherapy Penetrating thermotherapy Light therapy Electrotherapy Mechanical therapy 14 May 201517

18. Other Modalities Contrast therapy Phonophoresis Iontophoresis Biofeedback Hyperbaric O 2 therapy Therapeutic magnets 14 May 201518

19. Review Transmission of thermal energy Conduction Convection Radiation Conversion 14 May 201519

20. Cryotherapy Forms of cryotherapy Indications Contraindications 14 May 201520

21. Physiological Effects of Cryotherapy Decreases nerve impulses & conduction velocity Decreases muscle spindle activity Decreases tissue bleeding Decreases demand for O 2 fewer cells damaged Lowers tissue temperature Reduces pain & spasm 14 May 201521

22. Cold Sensations Cold Burning Aching Numbness 14 May 201522

23. Techniques of Application Ice bags 20-30 minutes Ice massage 10 - 15 minutes Immersion 5-12 minutes 14 May 201523

24. Considerations Frostbite???? Cold allergies Apply through a towel? Raynaud’s phenomenom Paroxysmal cold hemoglobinuria Nerve palsy 14 May 201524

25. Next time….. Thermotherapy Electrotherapy 14 May 201525