![Page 1: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/1.jpg)
Therapeutic Modalities
![Page 2: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/2.jpg)
• What is a Modality?• What role do modalities play in injury
rehabilitation? • How do we use Therapeutic Modalities?• When should we Modalities?
-Specific Types -Background -examples of application
Foundations of Therapeutic Modalities
![Page 3: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/3.jpg)
What are Therapeutic Modalities?
• mo·dal·i·ty /mōˈdalitē/– An intervention used to heal
someone – Agents such as light, heat, air, water,
manual, or electronic– All athletic trainers use therapeutic
modalities, some simple techniques other complex.
![Page 4: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/4.jpg)
Role of Modalities in Injury Rehabilitation
• Management or reduction of pain associated with an injury
• Return of full non-restricted ROM to an injury body part
• Maintenance or improvement of strength throughout the full ROM
o Use of Therapeutic Modalities inexact science, no cookbook for treatment
![Page 5: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/5.jpg)
Pain Management
• Control of pain is an essential aspect of caring for the injured patient
• Athletic trainer has several therapeutic agents with analgesic properties from which to choose– Acute Pain- pain of sudden onset – Chronic Pain- pain lasting for more
than 6 months
![Page 6: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/6.jpg)
Categories of Therapeutic Modalities
• Infrared Modalities– Therapeutic Heat & Cold– Ultrasound– Shortwave and Microwave Diathermy
• Electrical Modalities– Electrical Stimulating Currents– Iontophoresis
• Mechanical Modalities– Therapeutic sports Massage– Intermittent compression Devices– Spinal Traction
• Others
![Page 7: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/7.jpg)
Infrared Modalities• Thermotherapy- Heating techniques
used for therapeutic purposes – Used when a rise in tissue
temperature is the goal of treatment • Cryotherapy- The use of cold
– Used in the acute stages of the healing process immediately following injury when a loss of tissue temperature is the goal of therapy
![Page 8: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/8.jpg)
Hot &Cold Modalities Cont’d
• Most effective use of infrared modalities should be to provide analgesia or reduce sensation of pain associated with injury – Gate control theory of pain
modulation
![Page 9: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/9.jpg)
Cryotherapy• General agreement that cold should
be initial treatment for musculoskeletal injuries – Primary reason for using cold in acute
injury is to lower temperature in injured area thus reducing metabolic rate with a corresponding decrease in production of metabolites and metabolic heat (secondary hypoxic response) • More effective when combined with
compression
![Page 10: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/10.jpg)
Cryotherapy
• Cryotherapy techniques include
– Ice massage– Cold packs– Ice packs – Cold whirlpool – Cold spray
– Contrast baths– Ice immersion– Cryo-cuff– Cryokinetics
![Page 11: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/11.jpg)
Cryotherapy Techniques
• Application of cryotherapy produces a three- to four-stage sensation– Uncomfortable sensation of cold – Stinging– Burning or aching feeling– Numbness
• Caution should be exercised when applying intense cold directly to the skin
![Page 12: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/12.jpg)
Ice Massage
• Remove top 2/3 of paper or Styrofoam cup leaving 1” on bottom of cup as handle
• Apply using overlappingcircular or longitudinal strokes
• Once the skin is numb to fine touch treatment ends(7-10 min)
• Thermopane develops under ice cup the allows for smooth gliding
![Page 13: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/13.jpg)
Commercial Cold Packs
• Cold pack should be placed against wet toweling
• Mold cold pack around joint • Treatment time required
is about 20 minutes on - 20 minutes off
• Should be repeated for 2 hours
![Page 14: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/14.jpg)
Cold Whirlpool
• Fill appropriate size whirlpool with cold water and ice until temp. at 50° to 60° F
• Use for massaging action• Gravity-dependent positions should
be avoided with acute and subacute injuries
• A toe cap made of neoprene can be used
![Page 15: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/15.jpg)
Cold Spray & Stretch
• Flourimethane is used• Cooling is superficial• Useful in treating trigger
points • Spraying Technique
– Same direction– Proximal to distal
• Gate Control pain modulation• Stretching Technique
![Page 16: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/16.jpg)
Thermotherapy• Local superficial heating (infrared heat) is
recommended in subacute conditions for reducing pain and inflammation through analgesic effects
• Produces a relaxation effect and a reduction in muscle guarding by:– Relieving pain– Producing sedation– Decreasing spasticity, tenderness, and spasm– Decreasing tightness in muscles and related
structures
![Page 17: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/17.jpg)
Thermotherapy Techniques
• Warm Whirlpool• Hydrocollator Packs• Paraffin Bath• Infrared Lamps• Fluidotherapy
![Page 18: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/18.jpg)
Warm Whirpool
• Temperature Range– Upper Extremity 98° -110° F – Lower Extremity 98- 104° F – Full body 98° - 102° F
• Time of application should be 15 to 20 minutes
• Caution is indicated in gravity-dependent position in subacute injuries
• Whirlpool maintainance
![Page 19: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/19.jpg)
Hydrocollator Packs
• Canvas pouches of petroleum distillate
• Water temperature 170o
• 6 layers (1”) of toweling recommended
• Don’t lie on top of hot pack• Time of application should
be 15 to 20 minutes
![Page 20: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/20.jpg)
Paraffin Bath
• Mixture ratio of paraffin to mineral oil 2 pounds:1 gallon
• Mineral oil reduces temp of the paraffin to 126° F
• Extremity dipped into paraffin for a couple of seconds then removed to allow paraffin to harden
• Repeat until 6 layers have accumulated • Wrap in a plastic bag with several
layers of toweling
![Page 21: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/21.jpg)
Therapeutic Ultrasound
• Inaudible , acoustic vibrations of high frequency that produce either thermal or non-thermal physiologic effects
![Page 22: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/22.jpg)
Frequency of Wave Transmission
• Audible sound = 16-20 kHz• Ultrasound > 20 kHz• Therapeutic Ultrasound = 0.75-3 MHz
(1,000,000 cycles/sec)• Lower frequencies have greater depth
of penetration• Higher frequencies more superficial
absorption
![Page 23: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/23.jpg)
Ultrasound Cont’d
• Electrical Output
• Mechanical Vibration
• Acoustic Sound wave
• Absorbed In The Tissues
![Page 24: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/24.jpg)
Thermal Effects of Ultrasound
• Increased collagen extensibility• Increased blood flow• Decreased pain• Reduction of muscle spasm• Decreased Joint stiffness• Reduction of chronic inflammation
![Page 25: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/25.jpg)
Non-Thermal Effects of Ultrasound
• Increased fibroblastic activity• Increased protein synthesis• Tissue regeneration• Reduction of edema• Bone healing• Pain modulation
![Page 26: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/26.jpg)
Methods of ApplicationDirect Contact• Transducer should be small enough to
treat the injured area• Gel should be applied liberally• Heating of gel does not increase the
effectiveness of the treatment
![Page 27: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/27.jpg)
Methods Cont’d
Immersion• Good for treating irregular
surfaces• A plastic, ceramic, or rubber
basin should be used
• Tap water is useful as a coupling medium
• Transducer should move parallel to the surface at .3-5 cm
• Air bubbles should be wiped away
![Page 28: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/28.jpg)
Considerations for Determining Treatment
• Size of the area to be treated• What exactly are you trying to accomplish
– Thermal vs. non-thermal effects• Intensity of treatment
![Page 29: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/29.jpg)
Electrical Stimulating Currents
• Creating muscle contraction through nerve or muscle stimulation
• Stimulating sensory nerves to help in treating pain
• Creating an electrical field in biologic tissues to stimulate or alter the healing process
![Page 30: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/30.jpg)
Uses of Therapeutic E-Stim
• Muscle reeducation• Muscle pump contractions• Retardation of atrophy• Muscle strengthening• Increasing range of motion• Reducing Edema
![Page 31: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/31.jpg)
Muscle Re-Education
• Muscular inhibition after surgery or injury is primary indication
• A muscle contraction usually can be forced by electrically stimulating the muscle
• Patient feels the muscle contract, sees the muscle contract, and can attempt to duplicate this muscular response
![Page 32: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/32.jpg)
Muscle Pump Contractions
• Used to duplicate the regular muscle contractions that help stimulate circulation by pumping fluid and blood through venous and lymphatic channels back to the heart
• Can help in reestablishing proper circulatory pattern while keeping injured part protected
![Page 33: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/33.jpg)
Muscle Strengthening
• Current intensity should make muscle develop 60% of torque developed in a maximum voluntary isometric contraction (MVIC)
• Pulse duration should be set as close as possible to the duration needed for the motor nerve to be stimulated
![Page 34: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/34.jpg)
Electrode Placement
• Electrodes may be placed:– On or around the painful area – Close to spinal cord segment that innervates
an area that is painful – Over sites where peripheral nerves that
innervate the painful area becomes superficial and can be easily stimulated
– Over superficial vascular structures– Over trigger point locations– Over acupuncture points– In a criss-cross pattern around the point to be
stimulated so the area to be treated is central to the location of the electrodes
• If treatment is not working- change placement
![Page 35: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/35.jpg)
Therapeutic Sports Massage
• Mechanical stimulation of tissues by rhythmically applied pressure and stretching
• Effects of massage may be either reflexive or mechanical
![Page 36: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/36.jpg)
Guidelines for Massage• Positioning will allow relaxation,
prevent fatigue, and permit free movement of arms, hands, and body
• Weight evenly distributed and should shift from one foot to the other
• Fit your hands to contour of area being treated
• Hands should be warm• Appropriate Medium
![Page 37: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/37.jpg)
Hoffa Massage
• Classical massage technique which uses a variety of superficial strokes– Effleurage – Petrissage – Tapotment – Vibration
![Page 38: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/38.jpg)
Effleurage (Stroking)
• Every massage begins and ends with effleurage
• Increases venous and lymphatic flow
• Increases circulation to skin surface
• Start with a light pressure, move centripetally or centrifugally cosistently throughout treatment
![Page 39: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/39.jpg)
Petrissage(Kneading)
• Consists of kneading manipulations that press and roll muscles under fingers or hands
• Muscles are gently squeezed, lifted, and relaxed
• Hands may remain stationary or move along length of muscle or limb
• Purpose is to increase venous and lymphatic return and to press metabolic waste products out of affected areas through intensive vigorous action
• Can also break up adhesions between skin and underlying tissue
![Page 40: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/40.jpg)
Tapotment(Percussion)
• Uses a variety of percussive or beating techniques
• Used to increase circulation and blood flow
• Used to stimulate peripheral nerve endings
![Page 41: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/41.jpg)
Tapotment• Hacking• Slapping• Beating• Tapping • Clapping or cupping
![Page 42: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/42.jpg)
Transverse Friction Massage
• Technique for treating chronic tendon inflammation
• Purpose is to increase inflammatory response to progress healing process
• Use strong pressure in perpendicular direction to fibers for 7 to 10 minutes every other day
![Page 43: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/43.jpg)
Indications For Massage• increase coordination• decrease pain • decrease
neuromuscular excitibility
• stimulate circulation • facilitate healing• restore joint mobility• remove lactic acid
• alleviate muscle cramps
• increase blood flow• increase venous return• retard muscle atrophy• increase range of
motion• edema• myofascial trigger
points• stretching scar tissue
![Page 44: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/44.jpg)
Contraindications for Massage
• arteriosclerosis• thrombosis • embolism• severe varicose
veins• acute phlebitis• cellulitis
• synovitis• abscesses• skin infections • cancers • acute inflammatory
conditions
![Page 45: Therapeutic Modalities. What is a Modality? What role do modalities play in injury rehabilitation? How do we use Therapeutic Modalities? When should we](https://reader030.vdocuments.us/reader030/viewer/2022020217/5519ba305503466f578b493f/html5/thumbnails/45.jpg)
Prentice, William E. Therapeutic Modalities: for Sports Medicine and Athletic Training. 5th ed. New York: McGraw-Hill 2003.