PHYSMOD_LEC - INTRO TO PHYSICAL AGENTS

Represent the administration of thermal, mechanical, electromagnetic and light energies for a specific therapeutic effect.

Represent a group of interventions that are adjunctive components of a more comprehensive therapy plan

Physical Agents

Intervention

______ Includes soft tissue massage, mobilizations, manipulation, acupressure

_______ Includes Body mechanics, Pain relief, Home exercise programs, wellness, risk reduction

_______ Includes Flexibility, strengthening, relaxation exercise, neuromuscular re-education, balance, coordination, proprioception,

________ Includes Thermal,mechanical, acoustic and electromagnetic modalities

Manual Therapy

Patient Education

Therapeutic Exercise

Therapeutic Modalities

Therapeutic Modalities

Thermal : _____ & _____

Mechanical : _____, ____ & ______

Acoustic : ______

Electromagnetic : ______, laser,light therapy, ______

heat & cold

compression, traction, hydrotherapy

Ultrasound

Electrical stimulation, diathermy

Clinical Applications

1. Modulation of _____

2. Alteration of _______ activation

3. Decrease _____ and facilitate ______

4. Increase _________

pain

muscle

inflammation and tissue healing

tissue extensibility

Clinical Applications of Physical Agents

A very common chief complaint

• Via _______ theory

• _____ blood flow

• ______ swelling

• Reduce ______

1. Modulation of Pain

gate control theory

INC

DEC

compression

Effects of Physical Agents : Pain Reception

_____ fibers is small, myelinated. Transmits a sharp,stabbing, pricking localized pain

______ fibers is the smallest, unmyelinated and transmits dull, throbbing,aching,burning diffusely localized pain.

A-delta fibers ( 30 m/s)

C fibers (1-4 m/s)

Effects of Physical Agents : Pain Relief

______ Control Theory

a mechanism, in the spinal cord, in which pain signals can be sent up to the brain to be processed to reduce the possible perceived pain, or reduce it at the spinal cord itself.

Gate Control Theory

Effects of Physical Agents : Pain Relief

_ This theory tells that pain is modulated by endogenous opioid like peptides called opiopeptins or endorphins

Endogenous opioid system ( reduce pain)

2. Alteration of Muscle Activation

_______ Depolarization of peripheral nerves to recruit more motor units

_______ Reduction of pain and decrease motor nerve conduction or synaptic activity

Facilitation

Inhibition

3. DEC Inflammation and Facilitation Tissue Healing

_____ Phase

• Decrease blood flow & metabolic activity to reduce swelling

• Reduction of pain

• Minimize duration and residual effects

Inflammatory Phase

DEC Inflammation and Facilitation Tissue Healing

______ Phase

• It enhances blood flow and cellular activity to promote repair of damage tissues

Proliferative Phase

DEC Inflammation and Facilitation Tissue Healing

________ Phase

• Influence maturation and organization of collagen

• Restore functional integrity

Maturation Phase

Tissue Healing

What are the stages?

Hemostasis → Inflammation → Proliferation → Maturation

Tissue Healing Process

Inflammation : _____ days

Proliferation : ______ days

Remodeling : _______ days

4-6 days

4-24 days

21 days - 2 years

Tissue Healing Process: Inflammation Phase

Vaso____ → Vaso _____ → ____ Formation → ___cytosis

Vasoconstriction → Vasodilation→ Clot Formation → Phagocytosis

Tissue Healing Process: Proliferation Phase

_____ thelialization → ____plasia → ____ contracture → ________

Epithelialization → Fibroplasia → Wound contracture → Neovascularization

Tissue Healing Process: Maturation Phase

____ synthesis → _____ orientation → ____ injury

Collagen synthesis → Collagen fiber orientation → Healed Injury

Tissue Healing Stage: _______

Goal : Prevent further injury/ bleedings & clean open wound

Effective Agents : _____ compression, _____ & _____

Initial Injury

static compression, cryotherapy & hydrotherapy

Tissue Healing Stage: _______

Goal : Prevent/Dec joint stiffness , Control Pain, INC circulation

Effective Agents: Thermotherapy, Laser, Ultrasound, Hydrotherapy (exercise / immersion), Motor ES

Chronic Inflammation

Tissue Healing Stage: _______

Goal : Regain / maintain strength and flexibility, control scar tissue formation

Effective Agents: Motor ES, Water exercise, Thermotherapy, Ice massage, Compression

Remodelling

4. INC Tissue Extensibility

_____ facilitates elongation and deformation of collagen

Heat

Types of Physical Modalities

A. _____ - agents that INC/DEC tissue temperature

B.______ - agents that apply electrical current or electromagnetic radiation to induce physiological effects

C. ______ - apply force to INC/DEC pressure on body

Thermal

Electromagnetic

Mechanical

Thermal Agents: To INC/DEC tissue temp

______ : Hot moist packs, Paraffin wax bath, fluidotherapy

_______ : Ultrasound, Diathermy

________ : Ice pack , Vapocoolant spray, Cold whirlpool

Superficial Heating Modalities

Deep Heating Modalities

Cryotherapy ( cooling modalities)

Methods of Heat Energy Transfer:

______ : Hot moist pack, paraffin wax bath, ice/cold pack

______ : Cold whirlpool,

______ : Vapocoolant spray

______ : Ultrasound, diathermy

_____ Effect : mechanical to electrical energy

_____ Effect : electrical to mechanical energy

Conduction

Convection

Evaporation

Conversion ( Direct piezoelectric effect, reverse piezoelectric effect)

Mechanical Agents: INC/DEC pressure in body

____ - Hydrotherapy

____ - Intermittent cervical traction or Intermittent lumbar traction.

____ - Intermittent pneumatic compression

____ - Extracorporeal shockwave therapy

____ -Continuous mode or pulsed mode (US)

Water

Mechanical Traction

Compression

Pressure

Sound

Apply energy in the form of electromagnetic radiation or an electric current

Electromagnetic agents

Electromagnetic Agents : Electromagnetic Fields

______ - energy is transmitted by oscillatory motion in the form of electromagnetic waves

Example: ultraviolet radiation, diathermy, LASER, infrared radiation

Electromagnetic wave

Electromagnetic Agents: Electrical Currents

_____ - Use of electrical current to induce muscle contraction, changes in sensation, edema reduction and tissue healing

Example: Neuromuscular electrical stimulation , Transcutaneous electrical nerve stimulation

Electrical Stimulation

Usage of Physical Modalities: In clinic vs Home based

Ultrasound, Ice packs, Paraffin wax bath, Electrical stimulation, Hot moist packs, shortwave diathermy, traction

Home based:

Ice/ hot moist packs, Paraffin wax bath, manual traction, electrical stimulation

Precautions

• Relative contraindications

• Conditions or factors in which a patient is at risk of experiencing an adverse event

• Proceed with caution (special care, limitations, proactive measures)

Contraindications

• Absolute contraindications

• Conditions or factors in which treatment over a specific body region should not be applied

• Increased risk of adverse effects

Precautions

• Impaired sensation

• Pregnancy

• Old age

• Unconscious

• Young age

Contraindications

• Cancer

• Fever

• Hemorrhagic conditions

• Electronic implants

• Active Deep Venous Thrombosis

Documentation

Modality → Body Region → Patient position → Parameters → Rationale

1. HMP on anterior aspect of R thigh c pt in long sitting X 20

   mins to dec pain.

2. Pulsed US on anterior aspect of L shoulder c pt in supine

   using 3 MHz X 1.5 W/cm2 X 5 mins to reduce pain.

3. Mechanical cervical traction c patient in short sitting & neck

   in 200 of flexion using 10 kg during pull & 5 kg during

   release c 8-sec on & 8-sec off cycle for 15 mins to dec

   paracervical muscle spasm

"All the dinosaurs feared the T-Rex."

-Deadpool