1. Injury Treatment Ms. Bowman

2. Injury Treatment 2 areas o Therapeutic Modalities o Therapeutic Exercise

3. Therapeutic Modalities Non-exercise treatment options o Include the use of: Heat Cold Electrotherapy Massage Traction Ultrasound Compression Vocabulary o Indications-reasons/injuries where it is appropriate to use the modality o Contraindications-reasons/injuries where it is inappropriate to use the modality

4. Thermal Modalities Transfer energy to or from the tissues; exchange of energy based on a temperature gradient Energy transferred through o Conduction-between two objects that are touching o Convection-movement of a medium (water, air) o Radiation-transfer without the use of a medium o Conversion-energy changed to another form o Evaporation-liquid to gas state

5. Thermal Modalities Cryotherapy-application of cold modalities o Effects: Vasoconstriction Decreased rate of cell metabolism Decreased production of cell waste Reduction of inflammation Decreased nerve conduction Decreased pain Decreased muscle spam Decreased muscular force production

6. Thermal Modalities o Indications: Acute injury or inflammation Acute or chronic pain Small, superficial, first-degree burns Postsurgical pain and edema Use in conjunction with rehabilitation exercises Acute or chronic muscle spasms neuralgia o Contraindications: Cardiac or respiratory involvement Uncovered open wounds Circulatory insufficiency Cold allergy/cold-induced urticaria Anesthetic skin Advanced diabetes Peripheral vascular disease Raynaud’s phenomenon Lupus Cryotherapy Types: o Ice bag o Ice cup o Cold whirlpool o Ice immersion

7. Thermal Modalities Thermotherapy- application of superficial or deep heating agents o Effects- Vasodilation Increased rate of cell metabolism Increased delivery of leukocytes Increased capillary permeability Increased venous and lymphatic drainage Edema formation Removal of metabolic wastes Increased elasticity of collagen-rich tissues Analgesia and sedation of nerves Decreased muscle tone Decreased muscle spasm Decreased pain Increased nerve conduction and velocity

8. Thermal Modalities Indications: o Subacute or chronic inflammatory conditions o Reduction of subacute or chronic pain o Subacute or chronic muscle spasm o Decreased range of motion o Hematoma resolution o Reduction of joint contractures Contraindications: o Acute injuries o Impaired circulation o Advanced arthritis (vigorous heating) o Poor thermal regulation o Anesthetic areas o Neoplasms o thrombophlebitis Thermotherapy o Types: Superficial o Heat pack o Warm whirlpool o Warm immersion o Infrared lamps o Paraffin baths Deep Heat o Microwave diathermy o Shortwave diathermy o ultrasound

9. Deep Heating Agents Therapeutic Ultrasound-deep-penetrating modality capable of producing changes in tissue through both thermal and nonthermal mechanisms o Uses acoustical energy Effects o Deep-heating o Increase rate of tissue repair o Wound healing o Increased blood flow o Increased tissue extensibility o Breakdown calcium deposits o Reduction of pain o Reduction of muscle spasm o Deliver medications

10. Deep Heating Agents Ultrasound o Continuous Output Used for heating tissues o Pulsed Output Nonthermal effects o The closer the duty cycle is to 100% the more thermal effects there are. The lower the duty cycle, the less thermal effects

11. Deep Heating Agents Thermal Effects o Increased sensory nerve conduction velocity o Increased motor nerve conduction velocity o Increased extensibility of collagen-rich structures o Increased collagen deposition o Increased blood flow o Reduction of muscle spasm o Increased macrophage activity o Enhanced adhesion of leukocytes to damaged endothelial cells Nonthermal Effects o Increased cell membrane permeability o Altered rates of diffusion across the cell membrane o Increased vascular permeability o Secretion of cytokines o Increased blood flow o Increased fibroblastic activity o Stimulation of phagocytosis o Production of healthy granulation tissue o Synthesis of protein o Synthesis of collagen o Reduction of edema o Diffusion of ions o Tissue regeneration o Formation of stronger, more deformable connective tissue

12. Deep Heating Agents Contraindications o Acute conditions (continuous) o Ischemic areas o Areas of impaired circulation/artery disease o Over areas of deep vein thrombosis o Anesthetic areas o Over cancerous tumors o Over sites of active infection of sepsis o Over spinal cord or large nerve plexus (high doses) o Exposed metal that penetrates skin o Areas around eyes, heart, skull, or genitals o Over the thorax (pacemaker) o Pregnancy when over pelvic or lumbar areas o Over fracture site before healing is complete o Stress fracture sites or sites of osteoporosis o Over the pelvic of lumbar area in menstruating patients Indications o Joint contractures o Muscle spasms o Neuroma o Scar tissue o Sympathetic nervous system disorders o Trigger areas o Warts o Spasticity o Postacute reduction of myositis ossificans o Acute inflammatory conditions (pulsed) o Chronic inflammatory conditions (pulsed or continuous)

13. Deep Heating Agents Temperature Increases and Their Desired Effect Classification of Ultrasound Temperature Increase Used for Thermal Effects Mild1 ºC Mild inflammation, accelerating metabolic rate Moderate2°-3°CDecreasing muscle spasm, decreasing pain, increasing blood flow, reducing chronic inflammation Vigorous3°-4°CTissue elongation, scar tissue reduction, inhibition of sympathetic activity

14. Deep Heating Agents Rate of Ultrasound Heating (temperature increase per minute) Intensity Tissue Depth1MHz3MHz 0.50.04°C0.3°C 1.00.2°C0.6°C 1.50.3°C0.9°C 2.00.4°C1.4°C

15. Deep Heating Agents Shortwave diathermy-uses high frequency electromagnetic energy to produce deep heat within the tissue o Effects similar to thermal and nonthermal ultrasound

16. Deep Heating Agents Effects o Thermal- Increased microvascular perfusion Activation of fibroblast growth factors Increased macrophage activity o Nonthermal- Heating of large area of tissue o Heat retained 3 times longer than ultrasound

17. Deep Heating Agents Contraindications o Ischemia o Hemorrhage o Acute inflammation (thermal) o Metal within the output field o Pacemaker o Presence of moisture o Moist dressing, adhesive tape, skin creams o Skull (extreme caution) o Contact lenses must be removed before application over head o Pregnancy (over pelvis, abdomen, or lumbar) o Menstruating females (over pelvis, abdomen, or lumbar) o Unfused epiphyseal plates Indications o Acute trauma (nonthermal) o Acute inflammation (nonthermal) o Edema reduction (nonthermal) o Subacute inflammation o Pain syndromes o Muscle spasms o Chronic inflammation o Increase blood flow o Stretching collagen-rich tissues

18. Deep Heating Agents Precautions Against Metal Within the Field of Shortwave Diathermy In the EnvironmentNear or On the PatientIn the Patient Beds Treatment tables Chairs Wheelchairs Metal stools CPM Units Splints Braces Medical instruments Electrical modalities Jewelry Body piercings Earrings Watches Metal in pockets (keys, etc.) Belt buckles Zippers Metal underwire bras Hearing aids Orthodontic braces Dental fillings Implanted fixation devices External fixation devices Metal heart valves Artificial joints Metal IUDs Body piercings Cardiac pacemakers Implanted bone growth generators Phrenic pacers

19. Electrical Stimulation Electrical stimulation-modality that utilizes electrical currents Electricity-force created by an imbalance in the number of electrons at two points (poles) o Electrons flow in an attempt to equalize difference in charges—this creates an electrical current Negative pole-area of high electron concentration Positive pole-area of low electron concentration o Closed circuit-formed when a complete path is formed between the 2 poles o Electrical Currents Direct Current-uninterrupted, one directional flow of electrons; square wave Alternating Current-direction of flow changes from positive to negative in a cyclical manner; no true positive or negative poles; electrons go back and forth between electrodes Pulsed Current-one direction of flow that is interrupted by periods of no current flow

20. Electrical Stimulation Vocabulary o Electrode leads-wires that conduct the current to and from the generator, electrodes, and patient o Electrodes-introduce the current into the body; point where the electrode contacts the skin is where the electrons are converted into ions When placed closer together, current flows superficially When places farther apart, the deeper the current flows Stimulation Levels SubsensoryBetween the point at which the output rises from zero to the point where the patient first receives an electrical sensation SensoryStimulation of only sensory nerves MotorStimulation that produces a visible muscle contraction NoxiousStimulation of pain fibers

21. Electrical Stimulation Contraindications o Cardiac disability o Pacemakers o Pregnancy (over abdomen, pelvis, and lumbar regions) o Menstruation (over abdomen, pelvis, and lumbar regions) o Cancerous lesions o Sites of infection o Exposed metal implants o Areas of nerve sensitivity Carotid sinus Esophagus Larynx Pharynx Around or on eyes Upper thorax Temporal region o Severe obesity o Epilepsy o Electronic monitoring equipement Indications o Controlling acute and chronic pain o Reducing edema o Reducing muscle spasm o Reducing joint contractures o Inhibiting muscle spasms o Minimizing disuse atrophy o Facilitation tissue healing o Facilitating muscle reeducation o Facilitating fracture healing o Strengthening muscle

22. Electrical Stimulation Types o High-Voltage Pulsed Stimulation o Transcutaneous Electrical Nerve Stimulation (TENS) o Interferential Stimulation o Neuromuscular Electrical Stimulation o Iontoporesis o Microcurrent Electrical Stimulation

23. Mechanical and Light Modalities