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Therapeutic Modalities
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Introduction Therapeutic modalities create an optimal environment for injury repair (DO NOT “CAUSE HEALING”) Most common types of modalities Cryotherapy (cold) Thermotherapy (heat) Massage Electrical stimulation Therapeutic ultrasound
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Physiology Basics Vasodilation Vasoconstriction
Increased size of vascular structures Means more oxygen to the tissue Vasoconstriction Decreased size of vascular structures Useful for preserving compromised/injured cells/tissue
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Physiology Basics Analgesia Metabolic rate Inflammation
Diminished/reduced sensation Metabolic rate Activity level of cells Reducing MR can preserve cells damaged by injury Inflammation Series of events that hinder optimal function
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Cryotherapy (Ice) Physiological effects Decreased local metabolic rate
Important in preventing secondary hypoxic injury Decreased local blood flow Vasoconstriction Decreased presence of inflammation & the processes of inflammation
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Cryotherapy (Ice) Physiological effects Reduced swelling
Decreased nerve conduction velocity Analgesia- pain decreased
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Cryotherapy (Ice) Indications Acute injuries After activity Swelling
Spasm Pain Mild burns
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Cryotherapy (Ice) Contraindications Hunting response
Prolonged exposure to cold may lead to superficial vasodilation to protect cold bodypart Raynaud’s phenomenon Cold allergy
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Cryotherapy (Ice) Application Ice massage 7-10 minutes
Excellent for muscle spasm and deep soreness
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Cryotherapy (Ice) Application Ice bags, ice towels, or cold packs
15-20 minutes (no longer than 30) If using packs, be sure to avoid direct contact to protect skin! Cold whirlpool / ice immersion 5-15 minutes, degrees Duration and temperature depends on surface area immersed
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Thermotherapy (Heat) Physiological effects Increased local circulation
Vasodilation Increased local metabolic rate Increased collagen extensibility Increased nerve conduction velocity Analgesia
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Thermotherapy (Heat) Indications Contraindications Sub-acute injury
Prior to activity Reduce spasm/guarding Contraindications Acute injury Impaired sensation
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Thermotherapy (Heat) Application Warm whirlpool Contrast baths
Treat minutes (no longer than 30) degrees Contrast baths Switch back and forth between hot and cold 3:1 or 4:1 to induce “vascular pumping action” from repeated vasodilation/vasoconstriction Particularly useful for troublesome swelling or edema
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Thermotherapy (Heat) Hydrocollator packs Treat 20 minutes
degrees Will burn! Must pad with layered towels or covers!
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Thermotherapy (Heat) Paraffin bath
Great for angular extremities (hands & feet) degrees Wash body part Dip body part 4-5 times, then wrap in ice bag and towel Treat minutes Dispose of wax or return to bath for re-use Do not use with open wounds
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Massage Physiological effects Indications
Increased local blood flow (if done properly) Increased venous/lymph return Analgesia & sedative neurological effect Indications Sub-acute injury Soreness Persistent swelling
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Massage Contraindications
Acute injury (may disturb clotting mechanism) Fracture sites Open wounds
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Types of Therapeutic Massage
Effluerage Petrissage Tapotement Vibration Cross-friction
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Effluerage Slow, rhythmic, soothing strokes toward the heart
One hand always in contact w/ patient Use massage lotion or cream, gloves optional Helps calm/soothe athlete Encourages venous & lymph return
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Petrissage Deeper “kneading” of large muscle masses
Stimulates local circulation Eliminates muscle trigger points
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Tapotement Percussion, cupping, or hacking of the large muscle groups
Typical “health-spa” massage Invigorates- increases neural response Increases local circulation
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Vibration Rhythmic oscillations of larger muscle groups
Most often quads and hams Physiologically speaking, we are not really certain of its effects Perhaps largest benefit is psychological
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Cross-friction Best empirically-supported technique
Increases local blood flow Reduces sensation of pain Accommodation Useful in restoring full function & ROM Typical treatment lasts 5 minutes
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Electrical Stimulation
Many types available Transcutaneous Electical Nerve Stimulation (TENS) Useful for pain relief Portable units are very affordable Typically treat for 20 minutes
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Electrical Stimulation
Many types available Interferential quad polar (IFQP) Uses four pads Good for pain control Premodulated Bipolar (PMBP) Uses two pads Good for pain control when IFQP not ideal (small body parts, etc)
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Electrical Stimulation
Other types also available Settings: Higher frequencies tend to produce fast acting, comfortable treatment for acute injuries, while lower frequencies tend to elicit longer lasting relief for chronic injuries Typical treatment lasts 15 minutes at intensity of comfort for patient
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Therapeutic Ultrasound
Sound energy which results in deep heating to tissue May penetrate up to 3-5 cm when administered a 1 MHz, up to 1-2 cm at 3 MHz. Must keep ultrasound head moving to prevent burns Typical treatment lasts 5-6 minutes at intensity of w/cm2
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