Foundations 1- Modalities Review for Final

soft tissue mobilization

mechanical stimulation of tissues to normalize physiological responses

indications of STM

• muscle strains

• muscle spasms

• scar tissue/ adhesions

• tendonitis

• trigger points

• edema

physiological effects of STM- reflexive

stimulation of sensory receptors in the skin for the autonomic nervous system to change

physiological effects of STM- mechanical

• scar tissue and adhesion mobilization

• collagen remodeling

• increased lymphatic drainage

• increased bronchiole secretion

physiological effects of STM- systemic

• decreased pain via gate control theory

• releases endogenous opiates

• decreased muscle spindle activity (and thus spasms)

STM techniques

• effleurage

• petrissage

• tapotement

• transverse friction

effleurage

gliding for skin/ tissue warming

petrissage

kneading to reduce friction

tapotement

percussion for alertness

transverse friction

perpendicular strokes for chronic alignment

STM contraindications

• fever

• DVT

• skin infections

• acute inflammation

• acute injuries

• severe osteoporosis

cupping therapy

using glass or silicone cups to create suction via negative pressure that lifts the skin for scar tissue mobility

cupping indications

• chronic MSK pain

• headaches

• improving scar tissue mobility

physiological effects of cupping

• lifts skin and superficial fascia

• decreases chronic MSK pain

cupping parameters

apply for 5-12 minutes (can use with movement)

cupping contraindications

avoid over open wounds and skin lesions

what is therapeutic US

transmission of acoustic energy into tissues

indications of thermal US

chronic joint contractures and scar tissue

indications for pulsed US

acute injury repair, bone healing, and tissue regeneration

1 MHz US depth

3-6 cm (for deep tissues)

3 MHz US depth

1-2 cm (for superficial tissues)

duty cycle for pulsed US

20-50%

duty cycle for thermal US

100%

intensity for pulsed US

0.5-1.0 W/cm^2

intensity for continuous US

1.0-2.0 W/cm^2

time for US

5-10 min

time for continuous US

enough to raise tissue temperature 2-4 degrees C

physiological effects of thermal US

• increased blood flow

• increased collagen extensibility

• vasodilation

• increased metabolic rate

• decreased joint stiffness

physiological effects of nonthermal US

• increased cavitation

• increased cell membrane permeability

• increased ion diffusion

• increased collagen production

thermal

continuous US is the same as

pulsed US is the same as

non-thermal

contraindications of US

• malignancy

• pregnancy

• pace makers

• thrombophlebitis

• CNS tissue

• growth plates

• areas with decreased sensation

what is phonophoresis

using US to drive prescription meds through the skin

indications of phonophoresis

anything for specific target area requiring meds

• epicondylitis

• tendonitis

• bursitis

physiological effects of phonophoresis

meds go through the enzymatic barrier of the epidermis

phonophoresis mode

non-thermal (pulsed)

phonophoresis duty cycle

20%

phonophoresis frequency

1 MHz (deep) or 3 MHz (superficial)

phonophoresis intensity

0.5-1.0 W/cm^2

phonophoresis contraindications

• malignancy

• pregnancy

• pace makers

• thrombophlebitis

• CNS tissue

• growth plates

• areas with decreased sensation

short wave diathermy

use of radio waves to heat up deep tissues inside the body

SWD indications

• large treatment areas

• joint stiffness

• muscle spasms

physiological effects of SWD

• increased cell metabolism

• increased tissue extensibility

• muscular relaxation

contraindications of SWD

• metal implants

• pace makers

• pregnancy

TENS

biphasic pulsed current

TENS indications

pain relief

physiological effects of high freq TENS

A-beta fiber stimulation (gate control theory)

physiological effects of low freq TENS

beta-endorphin and dynorphin release (endogenous opiate theory)

TENS frequency for sensory

high (>80 pps)

TENS frequency for motor twitching

low (2-4 pps)

TENS phase duration for sensory

short (<100 usec)

TENS phase duration for motor twitching

long (100-300 usec)

TENS contraindications

• cancer

• pregnancy

• pace makers

• carotid sinus

• active infections

what is NMES

using current to make muscle contractions happen

NMES indications

• muscle re-education

• preventing disuse atrophy

• decrease muscle spasms

physiological effects of NMES

tetanic muscle contractions

NMES for tonic contraction frequency

medium (30-50 bps)

NMES for tonic contraction phase duration

long (200-300 usec)

NMES for twitching frequency

low (2-5 pps)

NMES for twitching phase duration

long (100-300 usec)

contraindications for NMES

• pace makers

• carotid sinus

• pregnancy

• cancer

• active infections

Russian

using current to make muscle contractions

russian indications

• muscle re-education

• preventing disuse atrophy

• to decrease muscle spasms

physiological effects of russian

tetanic muscle contractions

russian parameters

medium frequency (50 bps)

russian contraindications

• pace makers

• carotid sinus

• pregnancy

• cancer

• active infections

IFC

crossing currents for pain relief in a large area

IFC indications

pain relief

parameters of IFC

high frequency (80-150 pps)

IFC contraindications

• pace makers

• carotid sinus

• pregnancy

• cancer

• active infections

what is iontophoresis

using direct current (DC) to drive meds into tissues

iontophoresis indications

• inflammation

• calcium deposits

• scar tissue

inflammation

dexamethasone for

calcium deposits

acetic acid for

scar tissue

calcium chloride for

physiological effects of iontophoresis

drives charged ions into the tissues

iontophoresis parameters

40-80 mA x min

iontophoresis contraindications

• pace makers

• carotid sinus

• pregnancy

• cancer

• active infections

laser light therapy

using light to trigger cell responses

LLT indications

• wound healing

• epicondylitis

• carpal tunnel syndrome

• chronic pain

LLT physiological effects

light is absorbed by mitochondria and converted into ATP (cellular energy)

LLT parameters

dosed in J/ cm^2

LLT contraindications

• pregnancy

• cancer

• active infections

• hemorrhage

• over glands

dry needling

inserting fine filament needles into trigger points to normalize tissue

dry needling indications

• myofascial pain

• trigger points

• managing pain

local physiological effects of dry needling

• histamine release

• bradykinin release

• substance P release

• vasodilation

• angiogenesis

systemic physiological effects of dry needling

• A beta release

• A delta release

• C fiber release

• opiate neuropeptide release

dry needling parameters

• depth

• manipulation

• adding ESTIM

dry needling contraindications

• needle phobia

• laminectomy

• pregnancy

• immunocompromised

blood flow restriction

using a cuff to restrict flow

BFR indications

people who can't tolerate heavy loads

BFR parameters

• 20-40% IRM

• 30-15-15-15 reps

• 40-80% occlusion pressure

BFR physiological effects

• partially hypoxic environment creation

• increased lactic acid

• increased growth hormone

• muscle hypertrophy

BFR contraindications

• pregnancy

• clotting disorders

• DVT/stroke history

• HTN (>140 mmHg)

ESWT

using high pressure waves to treat MSK conditions

ESWT indications

• patella tendinopathy

• Achilles tendinopathy

• plantar fasciitis

ESWT parameters

1000-3000 strikes per treatment

ESWT contraindications

• bleeding conditions

• children

• pace makers

• pregnancy