742 Modalities

ultrasound therapy

a non-invasive method of treatment that uses high frequency sound waves to promote healing and reduce pain in soft tissues

electrical stimulation

encompasses a variety of techniques, each designed to elicit specific therapeutic effects through the application of electrical currents

thermal effects of ultrasound

through continuous emission, ultrasound waves increase tissue temperature, which improves tissue extensibility, reduces viscosity of fluid elements, and increases blood flow- this can be especially beneficial for treating chronic conditions

non-thermal effects of ultrasound

in pulsed mode, where ultrasound is emitted in intermittent bursts, the primary effects include increased cell membrane permeability and improved tissue repair- this mode is particularly useful for acute injuries to reduce swelling and decrease pain without the additional heat

pulsed ultrasound

this method emits sound waves in quick, intermittent bursts, allowing time for the tissue to cool between pulses; typical with therapeutic goals of stimulating tissue healing and reduce inflammation without an excessive heat build up

continuous ultrasound

ultrasound waves are emitted in a steady stream, leading to sustained heating effects; suited for treating chronic conditions where increased tissue temperature can help in alleviating pain, increasing collagen tissue extensibility, ans reducing muscle spasms

when to use ultrasound

• tendonitis

• bursitis

• muscle sprains or strains

• joint contractures

• scar tissue mobilization

• chronic inflammation conditions

• to accelerate recovery process, enhance repair of soft tissues, and aid in the absorption of fluid accumulations

frequency of ultrasound

1MHz for deep tissue & 3MHz for superficial tissue

ultrasound intensity

0.1-3.0 W/cm²

ultrasound duty cycle

determines the proportion of on-time to off-time (ex. 20% of the time on and 80% of the time off)

ultrasound duration

lasts between 5-10 minutes

ultrasound precautions

• ultrasound should not be used over areas with compromised sensation or circulation

• care should be taken over growth plates in pediatrics

• avoid areas of spinal column or where gas is present in the tissue (lungs)

contraindications for ultrasound

• malignancy

• pregnancy

• pacemakers or other electronic devices

• thrombosis

• eyes or reproductive organs

• infection

• impaired sensation or mentation

key underlying mechanisms for electrical stimulation

• neural induction

• pain management

• muscle contraction

neural induction- electrical stimulation mechanism

electrical stimulation prompts the depolarization of nerve cells, leading to the transmission of nerve signals that can inhibit pain, stimulate muscle contraction, or influence autonomic functions

pain management- electrical stimulation mechanism

According to gate control theory, electrical stim can block the transmission of pain signals to the brain. Additionally, it can stimulate the release of endorphins, the body’s natural pain killers

muscle contraction- electrical stimulation mechanism

by mimicking the action potential that comes from the CNS, electrical stim causes muscle contraction similar to that in voluntary muscle actions, beneficial for muscle training and recovery

transcutaneous electrical nerve stimulation (TENS)

primarily used for symptomatic pain relief, TENS is versatile and non-invasive, making it suitable for chronic pain management

TENS frequency

50-150 Hz high frequency for acute pain & 2-10 Hz low frequency for chronic pain

TENS intensity

should be comfortable and should not cause muscle contractions

TENS pulse duration

50-200 microseconds

TENS treatment duration

20-30minutes or up to several hours

TENS mode

continuous for steady pain relief; modulated or burst mode can be used to prevent adaptation

Neuromuscular electrical stimulation (NMES)

ideal for rehabilitation, NMES helps in muscle re-education, preventing atrophy, and strengthening muscles post injury

NMES frequency

35-50Hz

NMES intensity

high enough to produce a muscle contraction

NMES pulse duration

150-350 microseconds

NMES treatment duration

10-20 minutes

NMES duty cycle

10 seconds on, 50 seconds off

functional electrical stimulation (FES)

often used to assist individuals with spinal cord injury or stroke in performing functional tasks by stimulating the muscles involved in those tasks

FES frequency

20-50Hz

FES intensity

sufficient enough to perform the desired movement or task

FES pulse duration

200-300 microseconds

FES treatment duration

varies depending on task

FES pattern

can be synchronized with functional tasks, often in a cyclic manner to mimic natural movements

Interferential current (IFC)

utilized for deeper tissue penetration, reducing pain, and accelerating self healing processes without the discomfort typically associated with high intensity stimulation

IFC frequency

beat frequency set between 1-150Hz

IFC intensity

comfortable tingling sensation

IFC pulse duration

not adjustable within most units

IFC treatment duration

10-30minutes

IFC electrode placement

X-cross pattern to intersect the currents at the area of injury

high voltage pulsed galvanic stimulation (HVPGS)

uses high voltage but short duration pulses to stimulate deeper tissues for healing and pain relief, particularly effective in managing inflammation in deeper structures

HVPGS frequency

1-120 pulses per second

HVPGS intensity

high enough to notice a response without causing discomfort

HVPGS pulse duration

around 5-100 microseconds

HVPGS treatment duration

5-15 minutes

HVPGS wave form

twin peaked with an interphase interval to prevent polarization effects

indications for electrical stimulation use

• pain relief

• muscle re-education

• post-surgical rehab

• joint pain and swelling

• facilitation of wound healing

precautions for electrical stimulation

• electrode placement

• skin integrity

• seizure disorders

• over the eyes

contraindications for electrical sitmulation

• pregnancy

• heart conditions

• pacemaker or other electronic devices

• placement over carotid

• areas of skin irritation or wounds

• thrombosis

• malignancy