Modalities are Fun!

Sports Med 2

Therapeutic Modalities Guided notesCryokinetics.

• Modality: a physical technique or substance administered to produce a therapeutic or pain free affect.

• Legal concerns• Understand use of specific modalities• Accurate evaluation of injury• Avoid “shotgun” approach• Adhere to the law

Cryotherapy

• most common forms are; ice massages, cold immersion, and ice packs.

• Physiological effects of cryotherapy:• Muscle spasm• pain reception• blood flow up to 10-15 minutes• metabolic rate• joint stiffness

Therapeutic effects of cryotherapy:• pain • or prevent swelling• inflammation• Minimized secondary tissue damage.

Skin response to cryotherapy:

Stage 1

• Cold Sensation

• 0 – 3 min

Stage 2

• Mild burning, aching

• 2-7 min

Stage 3

• Anesthesia• 5-12 min

4. Adverse Conditions to Cryotherapy

• hypothermia• frostbite• cold allergies• Raynauds phenomenon

Contraindications for Cryotherapy

• lack of normal temperature sensibility• cold hypersensitivity• Raynaud’s disease• Coronary artery disease

Methods p 445…http://youtu.be/9hQsymsi5xUhttp://youtu.be/ucFQbSbKNJY

Ice massage Ice Immersion,

CWPIce Pack

Equipment

Indications

Application

Considerations

Cryokinetics

• Numb the part to pain free– Work toward regaining ROM– 3-7 min.

• Ice until numb• Exercise 3-7 min. • Ice 3-5 min• Repeat 5 times

Thermotherapy is Hot

• Thermotherapy: application of heat to treat injuries. Heat energy increases activity by conduction, convection, and radiation.

• Modes are moist, dry, superficial and deep.

• Physiological Effects of thermotherapy:• muscle spasm• pain perception• blood flow• metabolic rate• collagen elasticity • joint stiffness • Therapeutic effects of thermotherapy• pain• soft tissue extensibility

• Adverse Conditions to thermotherapy• burns• open wounds

• Contraindications of thermotherapy• loss of sensations• immediately after injury• impaired circulation• directly to eyes• during acute inflammation

MethodsMoist Heat Pack Warm Whirlpool

Equipment Hydrocullator packs, 160 degrees. Retain heat for about 20-30min. Terry cloth or towel

98-110 degressF. Heat 10 -20 min

Indication Warms and relax, reduction for spasm. Superficial only

convection, reduce swelling, spasms, and pain.

Applications Remove pack from water, cover, treat

Fill tank, put extremity in and heat

Considerations Never! Let athlete sit or lay on heat pack…burns

Light headedness, electrical outlets, cleanliness

Therapeutic ModalitiesElectrical stimulation

(electrotherapy)

• Electrotherapy: implies a flow of electrons between two points.

• Electricity is a form of energy that displays magnetic, chemical, mechanical, and thermal effects on tissue.

• Ampere: volume or amount• Ohm: resistance• Voltage: force• Watt: power.

• Electrical Stimulating Units: generate 3 different types of currents, which produce specific physiological tissue changes. AC, DC, and pulsed. All 3 send currents through the body. Their purpose is to trigger the peripheral nerves to stop pain.

Examples of Electric generators

• TENS: transcutaneous nerve stimulators

• NMES: neuromuscular electrical stimulators

• EMS: electrical muscle stimulator

• MENS: micro-current electrical nerve

stimulators

• Every nerve has an excitability threshold. This is what we get to play with, with the electrical stem. There are 3 types of nerve fibers: sensory, motor, pain. It is possible to produce different physiologic response by adjusting the treatment parameters.

Definition uses

DC (Majority)

Flows in one direction from positive to negative poles

Muscle contraction, movement

AC Current flow reverses once during each cycle

Pain control, muscle contraction

Pulsed 3 or more pulses, interrupted for short periods of time

Pain control, muscle rehab.

Waveforms: represents electrical current.DC

+

0

-

Waveforms: represents electrical current.AC

+

0

-

Waveforms: represents electrical current.Pulsed

+

0

-

Electrode Set up

• Electrode Setup: • Pads: directly to skin, up to 4 in. Set up in an

“X” pattern with the desired stimulation area in the center of the “X”.

Physiological effects of Electrical Stem.• depolarization of peripheral nerves Therapeutic effects of Electrical Stem.• stop pain Contraindication of electrical Stem. • pregnancy• electrical pace devices• cardiac arrhythmia

Electrical Stimulation

Equipment - Electrotherapy generator-Water-Pads-Towel

Indication -Pain perception-Muscle contraction-Strengthening-Stop atrophy-Muscle re-education

Application -Spray pads with water-Place pads securely-Turn on machine-Set parameters-Have them tell you when they feel something-Press start

Considerations -Same as contraindications

Therapeutic ModalitiesUltrasound

• Ultrasound: is an inaudible, acoustic sound wave modality used in sport medicine for the purpose of elevating tissue temperature, repairing soft tissues, and relieving pain.

• Ultrasound can be used for thermal or non-thermal effects on soft tissue.

Physiological Effects of Ultrasound:

• Thermal:

• elevated tissue temperature

• blood flow

• tissue extensibility

• local metabolismNon-thermal:

• cavitation

• fluid movement

• cellular permeability

Therapeutic Effects of Ultrasound:

• collagen tissues extensibility

• joint stiffness

• muscle spasm

• blood flow

Equipment descriptions

• generator: main piece of equipment for delivering therapeutic ultrasound

• applicator/ultrasound head: has crystals the rebound the acoustic waves.

• Piezoelectric effect: causes expansion and contraction of the crystals

• Effective radiating area: the part where the transducer produces sound waves.

• Ultrasound has a frequency range from 1 MHz – 3.3 MHz.

• 1 MHZ: better if there is a layer of fat, or you need to get to deeper tissue.

• 3MHz: better for superficial thermal/non-thermal effects

Ultrasound can be continuous or pulsed

Continuous Pulsed

-Energy remains constant 100% of the time-Thermal effects

-Energy is interrupted-Non-thermal effects

Method

Equipment Ultrasound machine, coupling agent/method: gel, water

Indications Soft tissue injury: sprain, strain, contusion. Decrease pain, increase blood flow for repair

Applications -Put coupling agent on US head-Continuous movement of sound head-Use firm, steady overlapping motion-2-8 min

Considerations -Not over large areas-Impaired circulation-Eyes-Spinal cord-Not over reproductive organs