Therapeutic Therapeutic ModalitiesModalities

IntroductionIntroduction

• Therapeutic modalities create an optimal environment for injury repair (DO NOT “CAUSE HEALING”)

• Most common types of modalities – Cryotherapy (cold)– Thermotherapy (heat)– Massage– Electrical stimulation– Therapeutic ultrasound

Physiology Basics

• Vasodilation– Increased size of vascular structures– Means more oxygen to the tissue

• Vasoconstriction– Decreased size of vascular structures– Useful for preserving

compromised/injured cells/tissue

Physiology Basics

• Analgesia– Diminished/reduced sensation

• Metabolic rate– Activity level of cells– Reducing MR can preserve cells damaged

by injury

• Inflammation– Series of events that hinder optimal function

Cryotherapy (Ice)

• Physiological effects– Decreased local metabolic

rate• Important in preventing

secondary hypoxic injury

– Decreased local blood flow

• Vasoconstriction

– Decreased presence of inflammation & the processes of inflammation

Cryotherapy (Ice)

• Physiological effects– Reduced swelling– Decreased nerve

conduction velocity• Analgesia- pain

decreased

Cryotherapy (Ice)

• Indications– Acute injuries– After activity– Swelling – Spasm– Pain– Mild burns

Cryotherapy (Ice)

• Contraindications– Hunting response

• Prolonged exposure to cold may lead to superficial vasodilation to protect cold bodypart

– Raynaud’s phenomenon• Cold allergy

Cryotherapy (Ice)

Application– Ice massage

• 7-10 minutes• Excellent for muscle

spasm and deep soreness

Cryotherapy (Ice)

Application– Ice bags, ice towels, or cold

packs• 15-20 minutes (no longer than

30)• If using packs, be sure to avoid

direct contact to protect skin!

– Cold whirlpool / ice immersion

• 5-15 minutes, 55-65 degrees• Duration and temperature

depends on surface area immersed

Thermotherapy (Heat)

• Physiological effects– Increased local circulation

• Vasodilation

– Increased local metabolic rate– Increased collagen extensibility– Increased nerve conduction velocity– Analgesia

Thermotherapy (Heat)

• Indications– Sub-acute injury– Prior to activity– Reduce spasm/guarding

• Contraindications– Acute injury– Impaired sensation

Thermotherapy (Heat)

• Application– Warm whirlpool

• Treat 15-20 minutes (no longer than 30)• 98-110 degrees

– Contrast baths• Switch back and forth between hot and

cold 3:1 or 4:1 to induce “vascular pumping action” from repeated vasodilation/vasoconstriction

• Particularly useful for troublesome swelling or edema

Thermotherapy (Heat)

– Hydrocollator packs• Treat 20 minutes• 150-160 degrees

– Will burn! Must pad with layered towels or covers!

Thermotherapy (Heat)

– Paraffin bath• Great for angular extremities

(hands & feet)• 125-127 degrees• Wash body part• Dip body part 4-5 times, then

wrap in ice bag and towel• Treat 20-30 minutes• Dispose of wax or return to

bath for re-use• Do not use with open wounds

Massage

• Physiological effects– Increased local blood flow (if done properly)– Increased venous/lymph return– Analgesia & sedative neurological effect

• Indications– Sub-acute injury– Soreness– Persistent swelling

Massage

• Contraindications– Acute injury (may disturb clotting

mechanism)– Fracture sites– Open wounds

Types of Therapeutic Massage

• Effluerage• Petrissage• Tapotement• Vibration• Cross-friction

Effluerage

• Slow, rhythmic, soothing strokes toward the heart

• One hand always in contact w/ patient

• Use massage lotion or cream, gloves optional

• Helps calm/soothe athlete• Encourages venous & lymph return

Petrissage

• Deeper “kneading” of large muscle masses

• Stimulates local circulation• Eliminates muscle trigger points

Tapotement

• Percussion, cupping, or hacking of the large muscle groups

• Typical “health-spa” massage• Invigorates- increases neural

response• Increases local circulation

Vibration

• Rhythmic oscillations of larger muscle groups– Most often quads and hams

• Physiologically speaking, we are not really certain of its effects

• Perhaps largest benefit is psychological

Cross-friction

• Best empirically-supported technique

• Increases local blood flow• Reduces sensation of pain

– Accommodation

• Useful in restoring full function & ROM

• Typical treatment lasts 5 minutes

Electrical Stimulation

• Many types available– Transcutaneous Electical

Nerve Stimulation (TENS)• Useful for pain relief• Portable units are very

affordable• Typically treat for 20 minutes

Electrical Stimulation

• Many types available– Interferential quad polar (IFQP)

• Uses four pads• Good for pain control

– Premodulated Bipolar (PMBP)• Uses two pads• Good for pain control when IFQP

not ideal (small body parts, etc)

Electrical Stimulation

• Other types also available• Settings:

– Higher frequencies tend to produce fast acting, comfortable treatment for acute injuries, while lower frequencies tend to elicit longer lasting relief for chronic injuries

• Typical treatment lasts 15 minutes at intensity of comfort for patient

Therapeutic Ultrasound

• Sound energy which results in deep heating to tissue

• May penetrate up to 3-5 cm when administered a 1 MHz, up to 1-2 cm at 3 MHz.

• Must keep ultrasound head moving to prevent burns

• Typical treatment lasts 5-6 minutes at intensity of 1-1.5 w/cm2