ALL Contraindications & Precautions - Physical Agenets

Contraindications to Cryotherapy

·       Cold Hypersensitivity (Urticaria)

·       Cold Intolerance

·       Cryoglobulinemia

·       Paroxysmal Cold Hemoglobinuria

·       Reynaud’s Phenomenon

·       Area of regenerating peripheral nerves

·       Area of circulatory compromise

Precautions to Cryotherapy

·       Superficial main branch of nerve

·       Open wound

·       Hypertension

·       Poor sensation

·       Poor mentation

• Very Young & Very Old

Contraindications to Thermotherapy

·       Hemorrhage

·       Thrombophlebitis

·       Impaired sensation

·       Impaired mentation

·       Malignancy

·       IR radiation of the eyes

Precautions to Thermotherapy

·       Acute injury/inflammation

·       Pregnancy

·       Impaired circulation/poor thermoregulation

·       Edema – elevate limb

·       Cardiac insufficiency

·       Metal

·       Open Wounds – NO PARAFFIN

·       Topical counterirritant w/ heat sensation

·       Demyelinated Nerves

Contraindications to Ultrasound

·       Malignancy

·       Pregnancy (in area where beam may reach fetus)

·       CNS tissue (over laminectomy)

·       Pacemaker or implanted devices

·       Eyes

·       Reproductive organs

·       DVT or thrombophlebitis

·       Active Bleed

·       Infection

·       Joint Cement

·       Plastic

Precautions to Ultrasound

·       Acute inflammation (no high dose/thermal)

·       Epiphyseal Plates (no >0.5 W/cm2)

·       Fractures (no high dose)

• Breast Implants (no high dose)

Contraindications to ALL diathermy

• Implanted or transcutaneous devices

• Pregnancy – clinician or patient

Contraindications to THERMAL diathermy

• Metal implants

• Jewelry

• Malignancy

• Eyes

• Testes

• Growing epiphyses

Contraindications to NON-THERMAL diathermy

• Deep tissues such as internal organs

• Substitute for conventional therapy for edema and pain

• Metal implant (looping)

Precautions to ALL diathermy

• Near electronic or magnetic equipment

• Obesity

• Copper-bearing intrauterine contraceptive devices

Precautions to NON-THERMAL diathermy

• Pregnancy

• Skeletal immaturity

Contraindications to traction

·       Acute spine trauma 

·       Acute Inflammation (RA)  

·       Joint hypermobility or instability  

·       Severe respiratory disease  

·       Malignancy (primary or metastatic)

·       Infectious disease of the spine (TB)  

·       Uncontrolled HTN (inversion/cervical)  

·       Spinal cord compression  

·       Aortic stenosis  

·       Pts. With surgical stabilization or decompression, spine implants or prosthetic discs  

·       When traction results in peripheralization of symptoms  

• Spine movement contraindicated

Precautions to traction

·       Structural disease of conditions affecting the integrity of tissues in the area being treated   

·       When pressure of belts may be hazardous –

·       Displaced annular fragment-may move  

·       Medial disc protrusion  

·       When severe pain fully resolves with traction  

·       Claustrophobia or psychological aversion  

·       Inability to lie supine or prone  

·       Impaired mentation or disorientation  

·       TMJ problems/dentures – cervical mandibular halter 

Contraindications to compression

·       Heart Failure    

·       Acute pulmonary edema  

·       Recent or acute DVT, thrombophlebitis  

·       Recent or acute pulmonary embolism  

·       Complete obstructed lymphatic or venous return  

·       Severe peripheral arterial disease/arterial insufficiency  

·       Acute local skin infection (cellulitis)  

·       Acute trauma  

·       Acute fracture  

·       Arterial revascularization  

• Significant hypoproteinemia  

Precautions to compression

·       Impaired sensation  

·       Impaired mentation  

·       Uncontrolled HTN  

·       Cancer  

·       Superficial peripheral nerves  

·       Stroke/cerebrovascular insufficiency 

Contraindications for ALL E-stim (TENS/Pre-Mod/IFC)

·       Demand Pacemaker or pacemaker dependent/implantable defibrillator

·       Unstable arrhythmia

·       Over carotid sinus – thoracic, cervical, shoulder upper lumbar and chest

·       Arterial or venous thrombosis/thrombophlebitis

• Pregnancy over or around the abdomen or low back/pelvis (except during labor/delivery)

Precautions for ALL E-stim (TENS/Pre-Mod/IFC)

·       Cardiac Disease

·       Impaired mentation

·       Impaired Sensation

·       Malignant tumors

·       Skin irritation/open wounds

Contraindications for E-stim for Soft Tissue Healing (HVPC/Iontophoresis)

·       Demand Pacemaker or pacemaker dependent/implantable defibrillator

·       Unstable arrhythmia

·       Over carotid sinus – thoracic, cervical, shoulder upper lumbar and chest

·       Arterial or venous thrombosis/thrombophlebitis

·       Pregnancy over or around the abdomen or low back/pelvis (except during labor/delivery)

·       Over in area of malignant tumors

• Iontophoresis after an intervention that may alter skin permeability (heat/cold)

Precautions for E-stim for Soft Tissue Healing (HVPC/Iontophoresis)

·       Cardiac Disease

·       Impaired mentation

·       Impaired Sensation

·       Malignant tumors

·       Skin irritation/open wounds

·       When performed for open wounds infection control – need new electrodes each time in wounds, use protective covers in inpatient rooms

Contraindications for E-stim for Muscle Contraction (NMES/FES/EMS)

·       Demand Pacemaker or pacemaker dependent/implantable defibrillator

·       Unstable arrhythmia

·       Over carotid sinus – thoracic, cervical, shoulder upper lumbar and chest

·       Arterial or venous thrombosis/thrombophlebitis

·       Pregnancy over or around the abdomen or low back/pelvis (except during labor/delivery)

·       When contraction of a muscle may disrupt healing

Precautions for E-stim for Muscle Contraction (NMES/FES/EMS)

·       Cardiac Disease

·       Impaired mentation

·       Impaired Sensation

·       Malignant tumors

·       Skin irritation/open wounds

• May cause DOMS 

Contraindications for Biofeedback

·       Acute inflammatory conditions – where muscle contraction may disrupt healing

·       Pregnancy and 6 weeks postpartum – no intervaginal devices  

·       Bladder or Vaginal infection – no intervaginal devices

·       Allergy to metal or electrode material

• Over eyes or other sensitive tissues  

Precautions for Biofeedback

• Impaired sensation

• Epilepsy

Contraindications for Lights & Lasers

·       Direct irradiation of the eyes (wear goggles with laser/UV)

·       Malignancy

·       Within 4-6 months after radiotherapy

·       In area of hemorrhage

• Over thyroid or other endocrine glands

Precautions for Lights & Lasers

·       Pregnancy – to low back or abdomen

·       Epiphyseal plates if not fully developed

·       Impaired sensation

·       Impaired Mentation

·       Photophobia or sensitivity to light

• Pretreatment with a photosensitizer