BPA: Indicators & Contraindications

Cryotherapy: Contraindications

Cold hypersensitivity (urticaria), Cold intolerance, Cryoglobulinemia, Hemoglobinuria, Raynaud’s disease, Regenerating peripheral nerve, Area of circulatory compromise/PAD

Cryotherapy: Precautions

Superficial branch of a nerve, open wound, Hypertension, Poor sensation, Poor mentation, Very young or very old patients

Cryotherapy: Indications

Inflammation control, Edema control, Pain control, Modification of spasticity—prolonged icing, Symptom management in MS—cooling vest, Muscle spasm cycle, Facilitation

Thermotherapy: Indications

Edema control (very rarely), pain control, joint stiffness & loss of ROM, muscle spasm, promotion of healing? (Wounds & soft tissues)

Thermotherapy: Contraindications of General heat

Acute; inflammation, recent or potential hemorrhage, thrombophlebitis. Impaired sensation, impaired mentation, malignancy, IR irradiation of the eyes, illness with fever

Thermotherapy: Contraindications of Paraffin

Open wound in the treatment area

Thermotherapy: Precautions

Acute injury or inflammation, pregnancy, impaired circulation (diabetes, PVD), poor thermal regulation, edematous areas, cardiac insufficiency, metal, open wound, topical counterirritants, demyelinated nerves

Thermotherapy: indications

Edema control (very chronic swelling not acute), pain control, joint stiffness & loss of ROM, muscle spasm, promotion of healing? (wounds and soft tissue)

Continuous Ultrasound: Indications

Soft tissue shortening, pain control

Pulsed Ultrasound: Indications

Dermal ulcers & surgical incisions, tendon & ligament injuries, fractures, carpal tunnel syndrome, phonophoresis

Ultrasound: Contraindications

Malignancy, pregnancy, CNS tissue (have you had a laminectomy?), joint cement & plastic, implanted electronic devices/pacemaker, thrombophlebitis, eyes and reproductive organs

Ultrasound: Precautions

Acute inflammation, epiphyseal plates, fractures, breast implants

Diathermy: Indications

Most indications for thermotherapy, greater depth of heating then superficial modalities and larger than ultrasound, muscle spasms, joint stiffness, (large joints and muscles), mild heating for recurring inflammatory conditions (most likely pain relief), Pulsed electromagnetic fields (PEMF)- superficial wound and bone healing

Diathermy: Contraindications

Where heat is contraindicated, implanted metal, cancer, over the eyes and reproductive organs , epiphyseal plates (growing), pregnancy (anywhere), implanted electrical devices

Diathermy: Precautions

Electronic or magnetic equipment nearby, obesity, copper IUDs. Should perform on wooden plinth, wood is non-conductive unlikely to cause burns

LASER: Indications

Musculoskeletal pain and inflammation, chronic skin wounds,

For LLLT:

-Positive evidence: fibromyalgia, myofascial pain syndrome, painful conditions of the spine, lateral epicondylitis, carpal tunnel syndrome

-Limited or conflicting evidence: shoulder pain and dysfunction, Achilles tendinitis, degenerative joint disease of the knee/hand, wound healing

For HILT:

-positive clinical outcomes are most likely caused by the thermal effects

LASER: Contraindications

Over the eyes, cancer, within 4-6 weeks of of radiotherapy, actively hemorrhaging area, over thyroid or endocrine glands

LASER: Precautions

Pregnancy (low back and abdomen), epiphyseal plates of children (growing), impaired sensation or mentation, photophobia or high sensitivity to light, pretreatment with a photosensitizer, tattoos or dark pigmented skin

Compression: Indications

Edema (both acute and chronic) - due to venous insufficiency or due to lymphedema, Prevention of DVTs, Treatment of venous stasis ulcers, Residual limb shaping for amputations, Control of hypertrophic scarring

Compression (intermittent or sequential compression pumps): CONTRAINDICATIONS

Heart failure or pulmonary edema; recent or acute DVT, thrombophlebitis, or PE; Obstructed lymphatic or venous return; Severe PAD; Acute local skin infection; Significant hyperproteinemia (<3gm/dl); Acute trauma/fracture; Arterial revasculaization

Compression/IPC: Precautions

Impaired sensation, impaired mentation, uncontrolled hypertension, cancer, stroke, superficial peripheral nerves

Ultraviolet Radiation: Indications

Psoriasis: PUVA or UVB

Infected/non-healing wounds: UVC

Ultraviolet Radiation: Contraindications

EYES, skin cancer, pulmonary TB, cardiac/kidney/liver disease, systematic lupus erythematosus, fever

Ultraviolet Radiation: Precautions

Photosensitizing meds, photosensitivity, recent x-ray therapy, previous dose effects still present (you can still see the “sunburn” from previous treatment)

Traction: Indications

Spinal disc bulge or herniation, spinal nerve root impingement, joint hypomobility, subacute joint inflammation, muscle spasm

Traction: Contraindications

Where motion is contraindicated, acute injury/inflammation, joint hypermobility or instability, peripheralization of symptoms with traction (eg. worsening fxn down legs), uncontrolled hypertension (in all cases but especially inversion tables)

Traction: Precautions

Structural disease/conditions affecting the spine, when belt pressure may be hazardous (eg. pregnancy), displaced annular fragment, medial disc protrusion, when severe pain FULLY resolves with traction (the spinal cord could be dangerously compressed), claustrophobia, inability to tolerate prone or supine position, disorientation, TMJ or dentures (cervical only)