1. © 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning BELLWORK Name as many of the therapeutic modalities you can remember from the Training Room. 1

2. © 2010 Delmar, Cengage Learning 2 © 2011 Delmar, Cengage Learning Chapter 12 Therapeutic Physical Modalities

3. © 2010 Delmar, Cengage Learning 3 © 2011 Delmar, Cengage Learning Objectives Upon completion of this chapter, you should be able to: –Explain the use and effectiveness of physical modalities –Describe the various thermal modalities and their applications 3

4. © 2010 Delmar, Cengage Learning 4 © 2011 Delmar, Cengage Learning Objectives (cont’d.) Upon completion of this chapter, you should be able to (cont’d.): –Explain and describe the use of therapeutic ultrasound –Explain and describe the use of electrical modalities 4

5. © 2010 Delmar, Cengage Learning 5 © 2011 Delmar, Cengage Learning Therapeutic Physical Modalities Therapeutic physical modalities –Heating, cooling, and mechanical/electrical methods of treatment used on the human body Physical modalities –Hot and cold treatments, therapeutic ultrasound, and various electrical modalities 5

6. © 2010 Delmar, Cengage Learning 6 © 2011 Delmar, Cengage Learning Therapeutic Physical Modalities (cont’d.) Used along with other forms of treatment –To relieve pain, reduce or retard swelling, decrease spasm, and promote healing Can minimize time lost from participation –Used improperly, condition may worsen 6

7. © 2010 Delmar, Cengage Learning 7 © 2011 Delmar, Cengage Learning Thermal Modalities Cryotherapy –Use of cooling agents (e.g., cold packs, cold bucket baths, and ice massage) –Most widely used therapy Responses include: reduction of tissue metabolism, decreased nerve conduction velocity, reduced muscle spasm, secondary vasodilatation, and increased in muscle strength If left on too long, counter effects may occur 7

8. © 2010 Delmar, Cengage Learning 8 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Ice packs –Effective for local areas of concern –Quick and economical Plastic bags with ice cubes Gel packs Chemical-activated cold pack –20 minutes 8

9. © 2010 Delmar, Cengage Learning 9 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Ice massage –Used for localized problems (e.g., tennis elbow, shin splints, Achilles tendonitis) –Typically water frozen in a cup –Only takes about 5-10 minutes 9

10. © 2010 Delmar, Cengage Learning 10 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Cold water compression –Cold and compression applied simultaneously –Sleeve w/internal water bladder –Raise container  gravity forces water into sleeve –15-20 minutes 10

11. © 2010 Delmar, Cengage Learning 11 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Ice baths –Immersion in a bucket of ice water Allows complete, uniform coverage Some exercise movements may be performed 55-65°F 10-15 minutes CBAN 11

12. © 2010 Delmar, Cengage Learning 12 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Contraindications/precautions –Cryotherapy should be used with caution on persons who have: Thermoregulatory problems Sensory deficits Hypersensitivity to cold Impaired circulation Heart disease Malignant tissue 12

13. © 2010 Delmar, Cengage Learning 13 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Heating agents –Heat is applied superficially (skin deep), or with a modality capable of heating tissues up to a few inches beneath the skin –Beneficial effects: Reduced pain Promotion of healing Increased range of motion Muscle relaxation 13

14. © 2010 Delmar, Cengage Learning 14 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Heating agents (cont’d.) –Localized vigorous heating effects: Substantially increased vasodilatation Increased metabolic rate and capillary pressure and flow Clearance of metabolites Oxygenation of tissue 14

15. © 2010 Delmar, Cengage Learning 15 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Hydrocollator packs –Moist hot packs used for superficial heating Kept warm in a heated stainless-steel container filled with hot water ~160-170°F Left in place for 10 to 20 minutes 15

16. © 2010 Delmar, Cengage Learning 16 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Contraindications/precautions –ATC must assess the condition and injury status –Heat is not used until 48 to 72 hours after injury –Heat dilates the vessels and could cause additional bleeding if healing is not adequate 16

17. © 2010 Delmar, Cengage Learning 17 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Contraindications/precautions (cont’d.) –Heat should not be used: In acute injuries, with athletes who have impaired circulation, in areas of diminished sensation, or with athletes who may be heat intolerant 17

18. © 2010 Delmar, Cengage Learning 18 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Hydrotherapy –Superficial heating Agitated, heated water in a whirlpool –Larger area on an extremity can be treated –Athlete can perform range-of-motion exercises –95-105°F –10-20 minutes 18

19. © 2010 Delmar, Cengage Learning 19 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Contrast therapy –Alternating hot and cold water baths for specified time periods –May be used in the sub-acute injury stage (48 to 72 hours after the injury incurs) –4 min hot, 1 min cold  end in cold –controversial 19

20. © 2010 Delmar, Cengage Learning 20 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Ultrasound –Deep-heating modality –High-frequency sound waves absorbed by tissues –Not recommended during acute injury stage –Duty cycle: 100% = continuous (thermal) 10, 20, 50% = pulsed (non-thermal) 20

21. © 2010 Delmar, Cengage Learning 21 © 2011 Delmar, Cengage Learning Thermal Modalities (cont’d.) Ultrasound—con’t –Frequency 1MHz = deep tissue (2-5 cm) 3MHz = superficial –Sound head 2, 5, or 10 cm –Coupling agent Gel or water –5-10 minutes

22. © 2010 Delmar, Cengage Learning 22 © 2011 Delmar, Cengage Learning Therapeutic Electrical Modalities Pass electrical currents through skin into the body causing nerve tissue stimulation –Use may be limited by law Two main categories: –Electrical stimulation (E-Stim) –Transcutaneous electrical nerve stimulation (TENS) 22

23. © 2010 Delmar, Cengage Learning 23 © 2011 Delmar, Cengage Learning Therapeutic Electrical Modalities (cont’d.) Electrical stimulation therapy –Effects include increasing range of motion and muscle strength, re-educating muscles, improving muscle tone, controlling pain, etc. –Neuromuscular electrical stimulation is most common –Controls motor nerves 23

24. © 2010 Delmar, Cengage Learning 24 © 2011 Delmar, Cengage Learning Therapeutic Electrical Modalities (cont’d.) Transcutaneous electrical nerve stimulation (TENS) –Commonly applied with a portable unit for pain control –Electric current is applied through a surface electrode pad that is in contact with the external skin surface –Controls sensory nerves 24

25. © 2010 Delmar, Cengage Learning 25 © 2011 Delmar, Cengage Learning Therapeutic Electrical Modalities (cont’d.) Contraindications –Electrical stimulation should not be used: Over the carotid sinus During pregnancy In individuals with pacemakers On people who are sensitive to electricity Any time active motion is contraindicated 25

26. © 2010 Delmar, Cengage Learning 26 © 2011 Delmar, Cengage Learning Conclusion Appropriate selection and use of physical therapeutic modalities can have a dramatic beneficial effect –The wrong selection can have an adverse effect Careful consideration of the nature and stage of the injury is mandatory 26