1. Therapeutic Modalities

2. Therapeutic Modalities
What are they?
Technique that aids healing
Important adjunct to therapeutic exercise
Why do we use them?
Crease optimal environment for injury to heal
Limit inflammatory process
Break pain-spasm cycle
How do you select a modality?
Site, type, severity

3. Therapeutic Modalities
Indication
Condition that could benefit from a specific modality
Contraindication
Condition that could be adversely affected from a specific modality

4. Therapeutic Modalities
All about ENERGY
Electromagnetic Energy- Electromagnetic spectrum Frequency and Wavelength
Inverse relationship between wavelength and frequency
Infrared Modalities
Cryotherapy
Thermotherapy
Acoustic Energy
Needs medium for transmission
Ultrasound
Other
Massage, traction, medication

5. Electromagnetic Spectrum
Infrared (Thermal Changes)
Cold packs
Cold whirlpool
Hot whirlpool
Paraffin
Hydrocollator

6. Transmission Radiation Conduction Convection Conversion Evaporation
Heat is transferred through space
Laser
Conduction
Heating or cooling through direct contact
Hot or ice pack
Convection
Heating or cooling indirectly through air or water
whirlpool
Conversion
Heating through other forms of energy
ultrasound
Evaporation
Icey Hot

7. Cryotherapy

8. Cryotherapy (cold) Infrared Modality Ice packs Ice massage
Cold whirlpool
Ice immersion
Cold sprays

9. Cryotherapy Indications Contraindications Acute injuries (24-72 hrs)
Pain control
Reduction of spasm
Contraindications
Allergies (Cold uticaria) or Hypersensitivity
Uncovered wounds
Arthritis

10. Cryotherapy Transmission of Energy’ Tissue cooling
Conduction, convection, evaporation
Tissue cooling
Temperature dependent
Tissue dependent
Fat, muscle
Time dependent
Type of cooling agent (ice vs. water)
Limb circumference
Ice pack is better than the chemical pack

11. Physiological Response to Cryotherapy
Vasoconstrition of small blood vessels
Cooled blood circulates and vasocontriction continues
Hunting Response
Intermittent period of vasodilation after minutes of cold application
Lasts for 4-6 minutes
Protection form tissue damage- but DOES NOT raise temperature to pre-application levels
Causes the redness

12. Changes Decreases in… Increases in… Blood flow Metabolic rate
Inflammation
Pain perception
Muscle spasm
Muscle fatigue
Collagen elasticity
Increases in…
Blood viscosity

13. Techniques Ice packs Chemical packs Ice massage
20 min
Chemical packs
15 min
Ice massage
5-10 min
Ice immersion/whirlpool
5-20 min
Vapocoolant sprays
Contrast bath

14. Stages of Cooling Stage 1: (0-3 min) Stage 2: (2-7 min)
Cold sensation
Stage 2: (2-7 min)
Mild burning and aching
Stage 3: (5-12 min
Skin anesthesia

15. Cryokinetics Alternating ice and exercise
Anesthesia allows for pain-free exercise

16. Thermotherapy

17. Thermotherapy Forms- Superficial and Deep Indications
Chronic injuries and pain
Muscle spasm/joint stiffness
Contraindications
Acute injuries
Impaired sensations
Decreased circulation
Impaired thermal regulation

18. Changes Increases in… Decreases in… Blood flow Metabolic rate
Collagen elasticity
Capillary permeability
Decreases in…
Pain perception
Muscle spasm
Joint stiffness
Blood viscosity

19. Techniques Moist Hot Packs Whirlpools Paraffin Bath Contrast Bath
Water temp degrees
10 min
Whirlpools
degrees
20 min
Paraffin Bath
degrees
Dip and soak OR dip and wrap
Contrast Bath

20. Ultrasound Acoustical energy transmitted to tissues via a medium
High frequency causes vibrations
Just like waves in the ocean

21. Electrotherapy Indications Contraindications Pain modulation
Muscle contraction
Contraindications
Loss of sensation
Over heart, brain, or spinal cord

22. Massage Mechanical responses Physiological responses
Venous and lymphatic drainage
Stretching of tissue
Physiological responses
Increase circulation, metabolism, waste removal
Body relaxation
Psychological responses
Humans respond to being touched

23. Traction Putting tensions on a body segment Indications
Joint hypomobility
Muscle spasm
Herniated disc
Nerve impingement or inflammation
Contraindications
Unstable bony structures
Patient discomfort