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Therapeutic Modalities
Therapeutic ModalitiesWhat are they?
Technique that aids healingImportant adjunct to therapeutic exercise
Why do we use them?Crease optimal environment for injury to healLimit inflammatory processBreak pain-spasm cycle
How do you select a modality?Site, type, severity
Therapeutic ModalitiesIndication
Condition that could benefit from a specific modality
ContraindicationCondition that could be adversely affected from
a specific modality
Therapeutic ModalitiesAll about ENERGY
Electromagnetic Energy- Electromagnetic spectrum Frequency and Wavelength
Inverse relationship between wavelength and frequency Infrared Modalities
Cryotherapy Thermotherapy
Acoustic Energy Needs medium for transmission
UltrasoundOther
Massage, traction, medication
Electromagnetic SpectrumInfrared (Thermal Changes)
Cold packsCold whirlpoolHot whirlpoolParaffinHydrocollator
TransmissionRadiation
Heat is transferred through space Laser
Conduction Heating or cooling through direct contact Hot or ice pack
Convection Heating or cooling indirectly through air or water whirlpool
Conversion Heating through other forms of energy ultrasound
Evaporation Icey Hot
Cryotherapy
Cryotherapy (cold)Infrared Modality
Ice packsIce massageCold whirlpoolIce immersionCold sprays
CryotherapyIndications
Acute injuries (24-72 hrs)Pain controlReduction of spasm
ContraindicationsAllergies (Cold uticaria) or HypersensitivityUncovered woundsArthritis
CryotherapyTransmission of Energy’
Conduction, convection, evaporationTissue cooling
Temperature dependentTissue dependent
Fat, muscleTime dependentType of cooling agent (ice vs. water)Limb circumference
Ice pack is better than the chemical pack
Physiological Response to CryotherapyVasoconstrition of small blood vesselsCooled blood circulates and vasocontriction
continuesHunting Response
Intermittent period of vasodilation after 15-30 minutes of cold application
Lasts for 4-6 minutesProtection form tissue damage- but DOES NOT
raise temperature to pre-application levelsCauses the redness
ChangesDecreases in…
Blood flowMetabolic rateInflammationPain perceptionMuscle spasmMuscle fatigueCollagen elasticity
Increases in…Blood viscosity
Techniques Ice packs
20 minChemical packs
15 minIce massage
5-10 minIce immersion/whirlpool
5-20 minVapocoolant spraysContrast bath
Stages of CoolingStage 1: (0-3 min)
Cold sensationStage 2: (2-7 min)
Mild burning and achingStage 3: (5-12 min
Skin anesthesia
CryokineticsAlternating ice and exercise
Anesthesia allows for pain-free exercise
Thermotherapy
ThermotherapyForms- Superficial and DeepIndications
Chronic injuries and painMuscle spasm/joint stiffness
Contraindications Acute injuriesImpaired sensationsDecreased circulationImpaired thermal regulation
Changes Increases in…
Blood flowMetabolic rateCollagen elasticityCapillary permeability
Decreases in…Pain perceptionMuscle spasmJoint stiffnessBlood viscosity
TechniquesMoist Hot Packs
Water temp. 158- 170 degrees10 min
Whirlpools96-104 degrees20 min
Paraffin Bath118-126 degreesDip and soak OR dip and wrap
Contrast Bath
UltrasoundAcoustical energy transmitted to tissues via a
mediumHigh frequency causes vibrations
Just like waves in the ocean
ElectrotherapyIndications
Pain modulationMuscle contraction
ContraindicationsLoss of sensationOver heart, brain, or spinal cord
MassageMechanical responses
Venous and lymphatic drainageStretching of tissue
Physiological responsesIncrease circulation, metabolism, waste
removalBody relaxation
Psychological responsesHumans respond to being touched
Traction Putting tensions on a body segment Indications
Joint hypomobilityMuscle spasmHerniated discNerve impingement or inflammation
Contraindications Unstable bony structuresPatient discomfort