Treatment Modalities

superficial heating agents

hot packs, fluidotherapy, paraffin, warm bath

superficial cooling agents

ice packs, ice massage, cold bath

ideal temperature for heating modalities

104-113

effects of temperature elevation

vasodilation, increase in oxygen uptake, elevates pain threshold, changes muscle spindle firing rate, decreased joint stiffness, increased muscle flexibility

how long it takes for subcutaneous tissue to reach max heating

6-8 minutes

heating time for hot packs

15-20 minutes

dip/immersion paraffin bath

two dips only

glove paraffin bath

6-10 dips to form glove, then wrap in plastic and towel

duration of paraffin bath procedure

10-20 minutes

duration of fluidotherapy

20 minutes

contraindications of heat modality

acute injuries, impaired circulation, peripheral vascular disease, decreased sensation, open wounds/infections

uses for cryotherapy

reduce pain, limit edema, relax muscles

when to use cryotherapy

for short-term pain relief to help the patient sleep and tolerate movement/exercise

duration of cryotherapy treatment

20 minutes

duration of ice massage

5-10 minutes

Use of ice massage

best for small areas

Contraindications of cryotherapy

Cold hypersensitivity

Cold intolerance

Cryoglobulinemia

Paroxysmal cold hemoglobinuria

Raynaud's phenomenon

Area of regenerating peripheral nerves

Area of circulatory compromise

cold urticaria

skin reaction to cold with redness, itching, and hives

cryoglobulinemia

blood contains large amounts of cryoglobulins proteins that become insoluble at reduced temperatures

Raynaud's disease

is characterized by exaggerated vasoconstriction in the extremities

Paroxysmal cold hemoglobinuria

rare blood disorder where immune system produces antibodies that destroy RBCs when a person goes from cold to warm temps

pallor

Extreme or unnatural paleness

cyanosis

appearing blue/purple in light skin tones and grayish in darker skin tones

erythema

redness of the skin due to capillary dilation

reverse piezoelectricity

electrical voltage causes a change in shape of the crystal in an ultrasound transducer, causing the crystal to transmit sound waves

diagnostic ultrasound

between 2-12 MHz, slow intensity and short duration, no thermal effects

therapeutic ultrasound

between 1-3 MHz, high intensity and long duration, thermal effect

how to use ultrasound

frequent movement of transducer in a small circular motion, maintain full contact between transducer and skin

Beam Non-uniformity ratio (BNR)

a numerical value that measures how evenly ultrasound energy is distributed across a treatment head, between 2:1-6:1

theoretical response to thermal ultrasound

increased tissue extensibility and blood flow, pain relief, mild pro-inflammatory response, reduced muscle spasms

theoretical response to non-thermal ultrasound

cavitation and acoustic microstreaming

cavitation

contraction/expansion of small bubbles in liquid that create micro-injury in tissue to stimulate repair

acoustic microstreaming

unidirectional fluid flow around cell membranes

indications of thermal ultrasound

joint stiffness, soft tissue injury, pain, chronic wounds, trigger points

precautions for ultrasound

bony prominences, damaged skin, lungs/intestines, spinal surgical area, regenerating nerves, sensation awareness

contraindications of ultrasound

certain body regions, pacemakers, active epiphysis, impaired circulation/sensation, implants, skin disease, infections

parameters for ultrasound

duty cycle, intensity, treatment time

effective radiating area

size of treatment area for ultrasound, based on size of crystal in transducer head

treatment area for ultrsouind

double the effective radiating area

lower frequency ultrasound treatment

1 MHz, has a greater transmission and used for deeper tissues

higher frequency ultrasound treatment

3 MHz, has a greater absorption and used for superficial tissues

absorption spectrum for ultrasound (low to high)

blood, fat, nerves, muscle, skin, tendons, cartilage, bone

duty cycle

the percentage of time that sound waves are being delivered, ratio of time on to time off

intensity

rate of energy transfer to an area

typical intensity for ultrasound used in clinics

1-1.5 W/cm²

desired effect of thermal ultrasound

greater absorptiond

desired effect of non-thermal ultrasound

lower absorption

mild thermal effect

increase in temp by 1 C, may accelerate tissue metabolism

moderate thermal effect

increase in temp by 2-3 C, may decrease spasms/pain and increase blood flow

vigorous thermal effect

increase in temp by 4+ C, may increase collagen fiber extensibility

photobiomodulation

use of lasers to stimulate increase cell respiration

low level laser therapy (cold laser)

can treat pain and inflammation but does not produce thermal effect and treatment time is longer

high intensity laser therapy

produces a thermal effect and used to treat pain/inflammation, more effective for deeper structures

parameters for laser therapy

power, treatment area, time, total dosage, tissue depth

equation for treatment time for laser therapy

(desired dosage*treatment area)/power

Desired dosage units

J/cm2

Power unit

W (J/s)

precautions for laser therapy

infection; impaired cognition; recently radiated tissue; areas of tattoos, moles, heavy tan, dense hair, or increased melanin

contraindications for laser therapy

epiphyseal lines, use of steroid, certain body regions

when to use high intensity laser therapy

patients with adhesive capsulitis, lateral epicondylalgia, and carpal tunnel syndrome

focused extracorporeal shockwave therapy

single impulse with high peak pressure meant to treat tissue at a greater depth

radial extracorporeal shockwave therapy

impulses generated by ballistic mechanism used to treat more superficial tissue

desired pain level for radial shockwave therapy

6

BAR

the unit of measure for the intensity applied by the handpiece and felt by the patient for shockwave therapy

contraindications for shockwave therapy

active malignancy, lungs, pregnancy, infection, major nerves, pacemakers, epiphyseal plates

mechanotransduction

energy through tissue stimulates interstitial and extracellular responses