Physical Agents Modalities Practical 1

Heat Indications

1. control pain

2. increase soft tissue extensibility

3. accelerate healing where more O2 released into cells and increased enzymatic activity

4. increased circulation where vessels are not compromised

5. interference with pain spasm pain

Heat Physiological Effects

1. Increase CO/decrease BP

2. Increase metabolic rate/decrease mm activity

3. increase pulse rate/decrease blood to internal organs

4. increase resting rate/decrease blood to resting mm

5. increase vasodilation/decrease stroke volume

6. increase pain threshold

Heat Contraindications

1. malignancy

2. recent or potential bleeding hemorrahage

3. thrombophlebitis

4. impaired sensation

5. impaired mentation

6. infrared radiation over eyes

Heat Precautions

1. acute injury

2. pregnancy

3. impaired circulation

4. poor thermal conductivity (SCI)

5. inflammation

6. metal around area

7. open wound

8. over area of counterirritant (icy-hot)

Heat Adverse Effects

1. burn

2. fainting

3. bleeding

4. tissue damage especially of skin or eye

Ice Indications

1. inflammation

2. control pain

3. reduce spasticity

4. control symptoms of MS

5. facilitate motor response with quick ice

6. cryokinetics and cryostretch

Ice Physiological Effect

1. alters metabolic processes

2. decrease pulse/increase cardiac output

3. decrease rr/increase stroke volume

4. decrease venous bp/increase arterial bp (if shivering)

5. alter neuromuscular activity

Ice Contraindications

1. cold hypersensitivity or cold-induced urticaria

2. cold intolerance (pain, numbness, or abnormal color change)

3. cryoglobinemia - where proteins stick together from cold and impair circulation

4. paroxysmal hemoglobinuria - death of rbc in response to cold which produced blood in urine

5. raynaud's phenomenon

6. over regenerating nerve

7. over an area of circulatory compromise

Ice Precautions

1. over main branch of a nerve

2. over an open wound

3. hypertension

4. impaired sensation

5. young or old

6. problems with communication or understanding

Ice Adverse Effects

1. tissue death

2. nerve damage

3. nerve conduction impairment

4. pain, numbness/tingling, hyperhidrosis (sweating)

5. vasodilation when constriction intended

Ice Specifications and Parameters

no longer than 15 minutes and wait at least 1 hour before reapplication

Heat Specifications and Parameters

1. Remove all jewelry on or near heating area

2. Use around 6-8 towels on or near the heating area

3. Consider body thickness, % of total area of the patient, metabolic status of patient, and superficial and deep structures before beginning heat therapy

4. Maintain correct body temperature based on type of heat therapy such as hot pakcs between 158-167 degrees fahrenheit

5. normally heat stays on around 15 minutes

Cervical Traction Specifications and Parameters

- Initial/Acute - 8-10#, static, 5-10min

- Joint Distraction - 20-29# or 7% of bw, 15s/15s, 20-30min

- Decrease Muscle Spasm - 11-15#, 5s/5s, 20-30min

- Disc/Soft Tissue - 11-15#, 60s/20s, 20-30min

Lumbar Traction Specifications and Parameters

- Initial/Acute - 29-44#, static, 5-10min

- Joint Distraction - 50# or 50-60% of bw, 15s/15s, 20-30min

- Decrease Muscle Spasm - 25% of bw, 5s/5s, 20-30min

- Disc/Soft Tissue - 25% of bw, 60s/20s, 20-30min

Traction Indications

1. Disc bulge or herniation

2. nerve root impingement

3. joint hypomobility (multi-segmental)

4. subacute joint inflammation

5. paraspinal muscle spasm

6. tightness

Traction Contraindications

1. joint hypermobility or stability

2. where motion is contraindicated

3. with acute injury or inflammation

4. peripheralization of symptoms with traction

5. uncontrolled hypertension for inversion (precaution for lumbar traction)

6. tumors

7. osteoporosis

8. bone or joint infection

9. those with conditions that harness fit may cause problems: vascular, pulmonary

Traction Adverse Effects

1. increase symptoms

2. occurrence of new symptoms such as pain -> weakness or pain -> numbness and tingling

3. pain at other non-tractioned spinal levels (discovery of spinal abnormalities)

4. rebound increase pain after initial application (reason for low initial force)

Traction Precautions

1. structural disease affecting the spine

2. where pressure belts may be hazardous

3. displaced annular ligament

4. medical disc protrusion

5. severe pain fully alleviated by traction

6. claustrophobia or disorientation

7. recent surgeries in treated area

8. can't tolerate traction postion

9. TMJ problems for cervical traction

10. dentures for cervical traction

11. pregnancy

12. hernia

Traction Physiological Response

1. joint distraction

2. reduction of disc protrusion

3. soft tissue stretching

4. muscle relaxation

Static Compression Specifications and Parameters

always after intermittent compression

use either a compression garment or lymphedema wrapping

UE 20-30 mm/hg

LE 15-50 mm/hg

Intermittent Compression Specifications and Parameters

- Edema 3:1, 80-100s inf/25-50s def, UE 30-60mmHg + LE 40-80mmHg, 2-3 hr rx time

- Venous Stasis 3:1 Ulcer, 80-100s infl/25-50s def, UE 30-60mmHg + LE 40-80mmHg, 2-3 hr rx time

- Residual Limb 4:1 Reduction, 40-60s infl/10-15s def, UE 30-60mmHg + LE 40-80mmHg, 2-3 hr rx time

Compression Indications

1. edema due to either lymphatic of venous insufficiency (intermittent + static)

2. DVT prevention (intermittent + static)

3. venous stasis with or without wounds (intermittent + static)

4. residual limb shaping after amputation (intermittent +static)

5. control of hypertrophic scarring (static)

Compression Contraindications

1. *HEART FAILURE, PULMONARY EDEMA, OR ORGAN FAILURE*

2. recent or acute DVT, thrombophlebitis, or pulmonary embolism

3. obstructed lymphatic or venous return

4. severe PAD or ulcer due to arterial insufficiency

5. acute local skin infection

6. significant hypoproteinemia

Compression Precautions

1. impaired sensation or mentation

2. uncontrolled HTN

3. cancer if history

4. CVA or vascular insufficiency

5. superficial peripheral nerves

6. very low bp

7. may use compression on open wound but need dressing

Compression Adverse Effects

1. aggravation of condition (more edema or aggravation or underlying condition)

2. pain

3. ischemia

4. impaired healing

5. tourniquet effect

Compression Physiological Response

1. improved fluid balance and circulation

2. reduced edema

3. prevention of DVT

4. tissue remodeling

5. scar improvement

Ultrasound Specifications and Parameters

- frequency based on depth of tissue

- duty cycle: thermal vs. nonthermal

- intensity

- duration: consider size and ERA

- area to be treated

- number and frequency of treatments

- sequence of treatments

Ultrasound Indications

1. soft tissue shortening

2. pain control

3. soft tissue healing/inflammation

4. joint inflammation

5. bone fractures

6. carpal tunnel syndrome

7. phonophoresis

Ultrasound Contraindications

1. malignant tumor

2. pregnancy

3. CNS tissue

4. joint cement

5. plastic components

6. pacemaker or implanted cardiac device

7. thrombophlebitis

8. eyes

9. reproductive organs

10. impaired mentation

Ultrasound Precautions

1. acute inflammation

2. epiphyseal plates

3. fractures (need specific parameters)

4. breast implants

Ultrasound Adverse Effects

1. bad response to cell or lotion

2. deep burn

3. periosteal pain

4. cross contamination

5. endothelial damage from standing waves

Ultrasound Physiological Response

1. increase cell membrane permeability

2. increase intracellular calcium, altered enzyme activity

3. increase mast cell degranulation (release antimicrobial cytotoxins)

4. increase chemotactic factor and histamine release

5. increase macrophage responsiveness

6. increase blood flow

7. increase nitric oxide synthesis by fibroblasts

8. increase proteoglycan synthesis by chondrocytes