| LEGAL CONCERNS - Athletic trainer must carefully follow laws that prohibit him or her from use of certain therapeutic modalities. - FDA requires hospitals to have calibration & safety check every 6 months on all therapeutic modalities. HOW ARE THE MODALITIES RELATED? - Electromagnetic energy o Electrical stimulating currents o Shortwave and microwave diathermy o Infrared modalities (hot pack, cold packs) o Ultraviolet therapy o Low-powered laser - Transmitted without a medium for support - All forms of electromagnetic energy travel at 300 million meters per second in a vacuum - Energy waveforms travel in a straight line - Reflected, refracted, absorbed, or transmitted - The lower the frequency, the longer the wavelength vice versa - Acoustic energy o Ultrasound Laws Governing Electromagnetic Radiations - Arndt-Schultz principle o No reactions or changes can occur in the body tissue if the amount of energy absorbed is insufficient to stimulate the absorbing tissues - Law of Grotthus-Drapper o If the therapeutic energy is not absorbed by the superficial tissues, it must be transmitted to deeper tissues - Cosine Law o The smaller the angle between the propagating ray and the right angle, the less radiation reflected and the greater the absorption - Inverse Square Law o The intensity of the radiation striking a particular surface is known to vary inversely with the square of the distance from the source o The father away the source, the less the intensity in the squared relationship TRANSMISSION OF THERMAL ENERGY - Conduction; Heating through direct contact with a hot medium - Convection; Heating indirectly through another medium such as air or liquid - Radiation; Transfer of heat through space from one object to another - Conversion; Heating through other forms of energy - The speed at which an impulse travels is due to cross-sectional diameter and insulation CRYOTHERAPY - The major therapeutic value of cold is its ability to produce anesthesia, allowing pain-free exercise. Physical Principles - In most cases the longer the cold exposure, the deeper the cooling. - At a temperature of 38.3º F (3.5º C), muscle temperature can be reduced as deep as 4 cm. Physiological Effects of Cold - 15 minutes or less at a temperature of 50º F (10º C) or less, vasoconstriction of the arterioles and venules in the area occurs. - Stimulation of the sympathetic nervous system and adrenal medulla, causing a secretion of norepinephrine and epinephrine. - Causing vasoconstriction is cooled blood circulating to the anterior hypothalamus. - Hunting response; Causes a slight temperature increase during cooling. o It prevents local tissue injury resulting from cold - Increase in blood viscosity and a decrease in vasodilator metabolites. - Cold does not reduce swelling that is already present. - Waste products that act as muscle irritants and cause spasm. - A muscle spasm can be decreased when cold is applied to decrease the gamma motor neuron activity and to decrease afferent muscle spindle and GTO activity. - Cold decreases free nerve ending excitability as well as excitability of peripheral nerves. (spasticity) - The extent of cooling depends on the thickness of the subcutaneous fat layer. - Hemorrhage control - Inflammation of a body part is an indication for the use of cryotherapy - Temporary cessation of nerve-ending function (Stinging, burning, aching & numbness) Special Considerations - Frostbite has been known to occur in subfreezing temperature of 26.6 to 24.8º F (-3 to – 4º C) - Raynaud’s phenomenon; Condition in which cold exposure causes vasospasm of digital arteries. - Contraindication o Peripheral vascular disease - Ectomorphic body type requires short time of cold treatment Cryotherapeutic Methods - Cold therapy can begin one to three days after injury - Melting ice is colder – Adding salt to ice (slushy mixture) Ice Massage Cold or Ice Water Immersion Ice Packs (Bags) Vapocoolant Sprays - Fluori-methane spray is used in the spray and stretch technique. - 30º angle, 12~18 inches (30~47 cm) from the skin. (Move 4 inch/second) - Decrease distal extremity arthritic pain - A-fiber are stimuated to reduce painful arc Cryokinetics; Combines cryotherapy with exercise. - 5~10 minutes Cold Whirlpool (50~60º F) Effectiveness; Most -----------------------------------? Least Ice > Gel packs > Chemical packs > Cold compression machines > Cold spray THERMOTHERAPY Physiological Effects of Heat - Heat has the capacity to increase the extensibility of collagen tissue. - Ischemia; Lack of blood supply to a body part. - ? O2 and CO2 tension/?antibodies & metabolic process/ ?histamine production/? circulatory rate Superficial Heat (3~5 mm) - Directly increases the subcutaneous temperature and indirectly spreads to the deeper tissues. - ? membrane permeability - Infrared radiation, hydrocollator, whirlpool - After 30 minutes infrared radiation, skin will be white patches and red blotches Special Considerations in the Use of Superficial Heat - Never apply heat when there is a loss of sensation - Nerve apply heat immediately after an injury - Never apply heat when there is decreased arterial circulation - Never apply heat directly to the eyes or the genitals - Never apply heat to abdomen during pregnancy - Never apply heat to a body part that exhibits signs of acute inflammation - Malignacy/Phlebitis Moist Heat Therapies - Superficial tissue is a poor thermal conductor. - Because a moist heat pack is a form of superficial heat, it does not increase the muscle tissue temperature Moist Heat Packs (150~195º F) Whirlpool Baths (102 ~ 110º F) - The whirlpool bath combines heated water and massaging action (air) - A warm whirlpool is a superficial heater. It will only hear the superficial tissues - ? 10 beats/min each above 98.6ºF with full-body warm whirlpool - Contraindication; Debridenment Paraffin Bath (118 ~ 126º F) - Paraffin bath therapy is particularly effective for injuries to the more angular body areas. - MED test is required - Molecular motion energy is produced Contrast bath - Technique that uses immersion in ice slush, followed by immersion in tepid water (93 to 98º F (33.9 to 37.7º C) - Loss of vascular integrity/ vascular exercise Fluidotherapy - Fluidotherapy consists of cellulose particles in which warm air is circulated. Deep Heat (2 inches / 7~9º F) - Shortwave diathermy, ultrasound, microwave diathermy Mottling; spotty reddening caused by excessive histamine release due to heat exposure Shivering is a method by which the body generates heat SHORTWAVE AND MICROWAVE DIATHERMY Shortwave Diathermy - Federal Communications Commission (FCC) has assigned a wavelength of 7.5 to 22 meters and a frequency of 13.56 or 27.12 megacycles per second for therapeutic purposes. - Contraindication; Metal screw or pin in shoulder/ Metal implants/ Sensory loss/ Hemorrhage - ? 5~7º F in deep tissue Microwave Diathermy - A coaxial cable consists of an insulated central conductor with tubular stranded conductors, which are separately by layers of insulation laid concentrically over the central conductor. - Wavelength of 12 ~33 cm and frequency of 915 ~2,450 magacycles. Comparing Microwave Diathermy and Shortwave Diathermy - Microwave provides deeper muscle heating and comparatively more skin heating than does Shortwave diathermy. - Eddy current = Heat producing current that is administered by means of induction coid or condenser plate of a short-wave diathermy unit ULTRASOUND THERAPY - Ultrasound can be applied either to the skin or through a water medium. - It stimulates the repair of soft tissue injuries and relieves pain. - Attenuation; A decrease in intensity as the sound enters deeper tissues. - Peizoelectric effect; Electrical current produced by applying pressure to certain crystals such as quartz. - Ultrasound is based on the reverse piezoelectric effect - Ultrasound waves are reflected by bone and absorbed by muscle - Ultrasound beam o Effective radiating area; That portion of the transducer that produces sound energy o Beam nonuniformity ratio (BNR); The amount of variability in intensity of the ultrasound beam. o Highest intensity found in the beam compared to the average intensity indicated by the power meter - Intensity o Range from 0.1 ~3 W/cm2 - Pulsed versus continuous ultrasound (17,000 cycles/second) o Duty cycle indicates the percentage of time that ultrasound is being generated - Indications o Thermal and nonthermal effects (? 7~9º F) o Nonthermal effects include cavitation and microstreaming. ?chronaxy - Application - Direct skin application o Coupling medium; Used to facilitate the transmission of ultrasound into the tissues § Because energy cannot be transmitted through the air § To prevent damage to the crystal - Underwater application - Bladder technique - Moving the transducer - Dosage and treatment time - Special considerations o Unmyelinated nerve/ Myositic Ossificans with obesity Ultrasound in Combination with Other Modalities - Ultrasound is commonly used in conjunction with other modalities. - 4 MHz will penetrate less than 1 MHz - Moving the sound head too fast decreases the effects of ultrasound Phonophoresis - Phonophoresis is a method of driving molecules through the skin with ultrasound. ELECTROTHERAPY Physical Principles - Ampere; Volume or amount - Ohm; resistance (Skin has impedance of 200 ?/cm - ? impedance with skin disease) - Voltage; Force - Watt; Power - Membrane must depolarize or hyperpolarize for muscle to be stimulated - Monophasic spike waveform delivered in pairs is used with high-voltage pulsed monophasic generators (HVPG) - Negative pole/cathode will cause local vasodilation under pad, irritation, tissue softening, & edema reduction Electrical Stimulating Units - Electrical currents include AC, DC, and pulsed. –Starting of direct current is called “make” o Small negative electrode sill stimulate more with direct current - Current parameters o Waveform o Modulation o Intensity o Duration o Frequency § 0.5 ~ 20 Hz for denerved muscle/Lower frequency for partial denervation in peripheral nervous system o Polarity o Electrode setup Indications - Pain Modulation (Analgesic effect; Excitement of ?-endorphins) – Low frequency (1~5 Hz) o Gate control o Descending pain control o Opiate pain control theory - Muscle contraction o Muscle pumping o Muscle strengthening o Retardation of atrophy o Muscle re-education --- For obesity athlete, electrical stimulation is more discomfort Iontophoresis - Iontophoresis uses electrical current to drive ions. Interferential Currents Low-Intensity Stimulators - Low voltage galvanic stimulation produce a chemical effect (ion movement) - Low voltage electrical stimulator area used to assist in treatment of pain & muscle spasms & to enhance venous returns Biofeedback - Control of pain can be accomplished by self-control LOW-POWER LASER - Laser; Light amplification by stimulated emission of radiation. MASSAGE Therapeutic Effects of Massage Mechanical Responses Physiological responses - Reflex effects - Relaxation - Stimulation - Increased circulation - Eliminate toxins - Facilitate removal of waste products in intermediate stage of injury Psychological responses Massage Strokes - Effleurage; Stroking – Gentle milking action/Soothing effect - Petrissage; Kneading - Friction; Heat producing – Scar, adhesion, muscle spasms and fascia - Tapotement; Percussion (Beat) o Cupping o Hacking o Pincing - Vibration; Rapid shaking Guidelines for an effective Massage Sports Massage - Low back strains Massage Lubricants Positioning of the Athlete Confidence Deep Transverse Friction Massage - Transverse massage is a method of deep transverse friction massage. Acupressure Massage TRACTION - Traction is commonly used in the cervical and lumbar spine. Physiological effects Indications Application - 30º in flexion (Angle of pull cervical) Manual traction Mechanical traction Positional Traction Wall-Mounted Traction Inverted Traction Special Considerations INTERMITTENT COMPRESSION UNITS - ?edema by lymphatic capillaries remove plasma and water Equipment Treatment parameters MAGNET THRAPY ULTRAVIOLET - Increased pigmentation - Vitamin D activation - To be lethal to microorganisms, the bactericidal effect at ultraviolet light requires an intensity of severe times less than the minimal effective dose (MED) RECORDING THERAPEUTIC MODALITY TREATMENTS - Grade I joint mobilization is appropriate for decreasing pain and spasm - Acuscope us used to assist in the treatment of sympathetic reflex-dystrophy - Point stimulators are used to reduction pain - Noncompliant patients are contraindicated in used of a continuous passive motion modality |
| Using Therapeutic Modalities |