1. Therapeutic Modalities
Sports Medicine 2
Lexington High School

2. Purpose
Muscle Spasm/Pain Cycle~ injury causes muscle spasms that cause pain that causes muscle spasms
Leads to decreased mobility
Therapeutic Modalities used to stop cycle
Misapplication can make injury worse

3. Choosing a Modality Is modality safe for this type of injury?
Will modality contribute significantly to rehab process and complete recovery?
Is person applying modality trained to use it?

4. Heating and Cooling Means
Conduction~ heat transfer by direct contact with another medium. (hot or ice packs)
Convection~ heat transfer by indirectly through secondary conductive medium. (air or liquid)
Radiation~ heat transfer by or from its source to surrounding environment in form of waves or rays. (ultraviolet light)

5. Heating and Cooling Means
Conversion~ heat transfer that takes place through other forms of energy, such as sound, electricity or chemicals. (Ultrasound, diathermy)
Evaporation~ heat transfer takes place when a liquid coverts into a gas. (perspiration)

6. Thermotherapy Treatments using heat
Increase the temperature of the body region to cause vasodilatation
Increases blood flow to area
Decreases pain and muscle spasms
Increasing flexibility to tissues
Comforting for most patients

7. Guidelines for Thermotherapy
Never apply to an area of decreased sensation
Never apply directly after injury
Never apply to eyes or genitalia
Never apply to a pregnant belly
Never apply over an open wound
Do not apply on pts with hx of diabetes

8. Moist Heat Packs Indications Contraindications Chronic Pain/Tendonitis
Lg jt. Contractures
Muscle Spasm
Chronic edema
Pre-heating to electrical stim tx
Contraindications
Existing fever
Cardiac irregularities
Decreased skin sensation
Infections
Active Bleeding
Acute inflammatory conditions

9. Clinical Application
Pack should be applied with several layers of towels or hot pack cover
Hydrocollator water temp = 170 degrees
Treatment time varies as indicated
Never lie or sit on hot pack due to increase in burns

10. Typical Reactions to Hot Pack
Feel comfortable warmth
Sensation of area relaxing
No sensation of burning should be felt

11. Paraffin Bath Indications Contraindications Chronic Pain Muscle Spasms
Chronic Edema
Chronic arthritis
Soften calloused hands
Contraindications
Existing fever
Infections
Hypertension
Acute inflammatory injuries
Wet hands/fingers
Open wounds

12. Clinical Application and Response
‘Glove hands’ with wax, frequent dip
Follow individual manufacturer directions
Feel comfortable warmth
Feel sensation of relaxation
No sensation of burning
Feeling of slight oil on hands after removal of wax

13. Ultrasound High frequency sound wave converted to heat
Can reach depths of 3-5 cm
Coupling mediums used to help sound waves penetrate the skin
Sound head moved in slow, circular pattern with contact at all times

14. Ultrasound Two Types of Ultrasound Thermal Effects Mechanical Effects
↑ collagen elasticity
↓ Joint stiffness
↓ Pain and spasm
↑ Blood Flow
Effects can last up to 1 hour after 5 minute tx.
Mechanical Effects
↑ Nerve conduction
Cell permeability altered from pressure changes
Mineral deposits dissolved
Micromassage
Protein synthesis promoted

15. Ultrasound Depths of Ultrasound
1Mhz Frequency: depth of penetration = up to 5 cm
3Mhz Frequency: depth of penetration = 1-2 cm

16. Ultrasound Intensity (W/cm²) 1 Mhz 3 Mhz 0.5 .04º C .3º C 1 .2º C
Ultrasound Rate of Heating per Minute
Intensity (W/cm²)
1 Mhz
3 Mhz
0.5
.04º C
.3º C 1
.2º C
.6º C
1.5
.9º C 2
.4º C
1.4º C

17. Ultrasound~ Suggested Uses
1Mhz for deep tissue
3Mhz for shallow tissue
Treatment time should be 5-10 minutes depending on area being treated
Ultrasound treatments not performed more than one time per day

18. Phonophoresis
Combination of ultrasound and medication driven into the skin through sound waves
Usually anti-inflammatory medication
Time and technique same as regular ultrasound

19. Cryotherapy Treatments using Cold Decreases tissue temperature
Skin Color change from white to red
Decrease in total blood flow
Decrease in nerve conduction

20. Cryotherapy Treatment Length
Average minutes, once an hour
Three phases of sensation:
Cold sensation lasting 0-3 minutes
Mild burning and aching lasting 2-7 minutes
Relative numbness lasting 5-12 minutes

21. Guidelines for Cryotherapy
Use of a barrier, except in ice massage
Never on anesthetize skin
Never on open wounds
Never on someone with desensitized skin
Monitor for signs of Raynaud’s Phenomenon, condition in which the arteries and arterioles of an extremity constrict extensively. Causes extensive arterial blood flow.

22. Ice Packs Indications: Contraindications: Acute trauma Acute Pain
Heat Illness
Muscle Fatigue
Spasms
Post-op Pain
Acute Edema
Contraindications:
Circulatory insufficiency
Cardiac Problems
Open wounds
Anesthetic skin
Hypersensitivity to cold
Raynaud’s Disease

23. Clinical Application of Ice Pack
Directly to injured area
Frequency should be 20 minutes for every waking hour in acute injuries
No longer than 20 minutes (veins begin to vasodialate to warm body)
Used primarily for the first hours of an injury

24. Typical Response to Ice Pack
Cold→Burning→Aching→Numbness
Numbness takes from 3-7 minutes
Treatment usually satisfactory when skin turns pink or red

25. Ice Massage Indications: Contraindications Acute Trauma Acute Pain
Muscle pain/spasm
Post-op pain
Heat Illness
Acute tendonitis
Contraindications
Circulatory insufficiency
Cardiac Problems
Open wounds
Anesthetic skin
Hypersensitivity to cold
Raynaud’s Disease

26. Clinical Application/ Responses
Ice should have round edges
Continuous movement of ice to prevent tissue freezing
5-10 minutes, 4-6 times a day
Cold→Burning→Aching→Numbness
Numbness takes from 3-7 minutes

27. Cold Whirlpool/Ice Immersion
Indications:
Acute Trauma
Acute Pain
Muscle pain/spasm
Post-op pain
Heat Illness
Acute tendonitis
Contraindications
Circulatory insufficiency
Cardiac Problems
Open wounds
Anesthetic skin
Hypersensitivity to cold
Raynaud’s Disease

28. Clinical Application Frequency of treatment is 20 minutes
Cool = 67º - 80º F . . Use for spasticity
Cold = 55º - 67º F . . Use for inflammation and acute injury
Very Cold = 33º - 55º F . . Use for acute injury and pain relief
Encourage athlete to work on ROM while in the whirlpool or cold bath

29. Typical Reactions
Athlete will usually be uncomfortable and not want to do treatment
Cold→Burning→Aching→Numbness
If water is constantly moving, athlete may never achieve complete numbness

30. Contrast Bath
Theory is that the cold vasoconstricts the veins and the heat vasodialates the veins creating a pumping motion to push edema out of the area
Indications and Contraindications same as those for Thermotherapy and Cryotherapy

31. Clinical Application If swelling is anticipated end in cold
Work to ending in hot
Hot water should be 95º-110º, and cold water should be 55º-65º
Encourage athlete to work on increasing ROM
Use a 2:3 ratio of cold to hot or hot to cold
Treatment should last between 20 and 30 minutes

32. Electric Modalities
Use of electricity to influence healing by stimulating the body tissues

33. Guidelines for Electrical Modalities
Follow all MD guidelines
Explain procedure to the patient
Expose and clean area to be treated
Place electrodes in appropriate place
Use equipment as prescribed
Never use on an open wound

34. Electrical Stimulation
Effects:
Management of pain through gate control theory
Increase in deep blood flow and lymphatic drainage
Slight increase in circulation
Muscle relaxation

35. Electrical Stimulation
Indications:
Pain
Edema
Spasm
Hematoma
Trigger Point
Early muscle re-education
Contraindications:
Metabolic diseases
Children
Pacemaker
Tumor
Fever
Irritated skin

36. Clinical Application Follow MD recommendations for dosage
Treatment time should be minutes
Each person has different levels that they can tolerate, use the athlete as the guide
Athlete should feel a comfortable ‘moving’ tingling zone in the area around the treatment pads

37. Iontophoresis Use of ions to penetrate medicine into the injured area
1 cm penetration of medicinal ions
Numbing effect
Advantageous over Injectable:
No chance of infection
No tissue trauma
Medication is only thing going through skin

38. Iontophoresis Indications: Contraindications: Trigger points
Tendonitis
Superficial inflammatory conditions
Plantar Warts
Myositis
Bursitis
Contraindications:
Superficial metal implants
Pacemaker
Allergy to drug being used
Acute injury
Anesthetic skin

39. Clinical Application Must have a prescription for use of medicine
Follow MD guidelines for dosage
Must use appropriate medicines
Athlete should feel some pain relief
Athlete should not feel ‘hot pin’ sensation

40. Diathermy High frequency electrical current to heat the body’s tissue
Bigger machines, not popular

41. Diathermy Indications: Contraindications: Chronic sprains/strains
Limited ROM
Sub-acute inflammations
Contraindications:
Acute inflammatory injuries
Hemorrhages
Casts
Metal implants
Screws
Pregnant women

42. Clinical Application Sound heads placed around the area being treated
Remove all metal from area
Cover the area with 2 layers of towels
Should feel like a ‘ray of sunshine’ on the skin
Heats tissues to ºF at about 2 inches from skin’s surface