MODALITIES

thermotherapy

• heat; should be used after inflammatory phase (wait 48hrs)

• effects:

  • decrease muscle guarding, joint stiffness, pain perceptions

  • increase blood flow (vasodilation), metabolic rate, collagen extensibility, capillary permeability, edema

• type: conduction, convection, radiation, conversion

conduction

• heat transferred from warmer object to cooler one

• EX: moist packs, paraffin

convection

• transfer of heat through movement of fluids or gases

• temp, speed of movement, conductivity of part impact heating

• EX: whirlpools

radiation

• heating transferred from 1 obj through space to another

• EX: shortwave diathermy, infared heating UV, therapy

co

conversion

• generation of heat from another object (sound, electricity, or chemical agents)

• EX: ultrasound (sound → heat)

moist hot pack

• general muscle relaxation and reduction of pain-spasm-ischemia-hypoxia-pain cycle

• limitation: unable to heat deeper tissues effectively

• precautions: temp of 116.6 F will cause tissue damage and temps of 113F should not be in contact with skin longer than 30 mins (be careful w/ burns); athlete comfy and should not lie on pack

paraffin bath

• paraffin wax and mineral oil combination, heated b/w 126-130F and plastic bags, paper towels, and towels

• indications: useful in treating chronic injuries (arthritis) and effective for angular areas of body such hands, wrists, elbows, ankles, and feet

• application: body part cleaned/dried, dip and wrap technique*, soak technique

cryotherapy

• ice good for within 1st 6hrs

• effects:

  • decrease muscle guarding, pain perception, blood flow (up to 10 mins), metabolic rate, collagen elasticity

  • increase joint stiffness

• response to cold: cold sensation (0-3m), mild burning/aching (2-7m), relative numbness (5-12m)

whirlpool bath

• combo of massage and water immersion

• provides conduction and convection, swelling, muscle spasm and pain

• application: cold: 3-10m, hot: 15-30m, contrast: 3:1 (hot:cold)

• cold ice bath: less than 55 F

ice massage

• foam cup w frozen water (creating cylinder of ice)

• indications: used over small muscle areas (tendons, belly of muscle, bursa, or trigger points)

• ice rubbed over skin in overlapping circles (10-15cm) for 5-10 mins; pt experience sensations of cold, burning, aching, and numbness → when analgesia reached athlete can engage in rehab

cryokinetics

• movement while cold (not always best method)

• goal: numb region to point of analgesia and work toward achieving normal ROM

• treat area w ice pack, massage, or immersion

• analgesia experience = exercises should be performed (window lasts 3-5m), pain returns = repeat process up to 5x, exercise should be pain free, changes in intensity limited by both healing and pt pain perception

cold special considerations

• cold uticaria: ice on too long (itchy, uncomfy, skin damage)

• raynauds: do not apply ice esp on hand (shoulder and knee maybe)

electrical energy

• decrease pain sensation, produce muscle contraction, alter healing process (direct current)

• types of current: monophasic (direct), biphasic (alternating), biphasic (pulsaltile)

• equipment: TENS (transcutaneous electrical nerve stimulators) & NEMS/EMS (Neuromuscular electrical stimulators or electrical muscle stimulators)

waveform characteristics

intensity, duration, frequency, polarity

intensity

pulse amplitude (height)

duration

pulse width

frequency

number of waves per sec (pps)p

polarity

direction of current

gate control

• intensity should produce tingling without muscular contraction

• high freq and pulse duration

• all machines do this in some way

• trying to block pain sensations

descending pain control

• high current intensity approaching noxious level (mild discomfort)

• pulse duration of 10 msec; freq should be 80 pps

muscle strengthening

• high freq AC current; 50-60 pps; 15:50 s on/off ratio; 10 reps; 3x per week; perform with active contractions

muscle reeducation

• level of comfortable contraction: 30-50pps with either interrupter or surge current

• athlete should attempt to contract muscle along w stim

• treatment time 15-20m and repeated multiple times over course of week