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Therapeutic Modalities
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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
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Therapeutic ModalitiesIndication
Condition that could benefit from a specific modality
ContraindicationCondition that could be adversely affected from
a specific modality
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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
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Electromagnetic SpectrumInfrared (Thermal Changes)
Cold packsCold whirlpoolHot whirlpoolParaffinHydrocollator
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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
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Cryotherapy
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Cryotherapy (cold)Infrared Modality
Ice packsIce massageCold whirlpoolIce immersionCold sprays
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CryotherapyIndications
Acute injuries (24-72 hrs)Pain controlReduction of spasm
ContraindicationsAllergies (Cold uticaria) or HypersensitivityUncovered woundsArthritis
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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
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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
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ChangesDecreases in…
Blood flowMetabolic rateInflammationPain perceptionMuscle spasmMuscle fatigueCollagen elasticity
Increases in…Blood viscosity
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Techniques Ice packs
20 minChemical packs
15 minIce massage
5-10 minIce immersion/whirlpool
5-20 minVapocoolant spraysContrast bath
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Stages of CoolingStage 1: (0-3 min)
Cold sensationStage 2: (2-7 min)
Mild burning and achingStage 3: (5-12 min
Skin anesthesia
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CryokineticsAlternating ice and exercise
Anesthesia allows for pain-free exercise
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Thermotherapy
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ThermotherapyForms- Superficial and DeepIndications
Chronic injuries and painMuscle spasm/joint stiffness
Contraindications Acute injuriesImpaired sensationsDecreased circulationImpaired thermal regulation
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Changes Increases in…
Blood flowMetabolic rateCollagen elasticityCapillary permeability
Decreases in…Pain perceptionMuscle spasmJoint stiffnessBlood viscosity
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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
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UltrasoundAcoustical energy transmitted to tissues via a
mediumHigh frequency causes vibrations
Just like waves in the ocean
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ElectrotherapyIndications
Pain modulationMuscle contraction
ContraindicationsLoss of sensationOver heart, brain, or spinal cord
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MassageMechanical responses
Venous and lymphatic drainageStretching of tissue
Physiological responsesIncrease circulation, metabolism, waste
removalBody relaxation
Psychological responsesHumans respond to being touched
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Traction Putting tensions on a body segment Indications
Joint hypomobilityMuscle spasmHerniated discNerve impingement or inflammation
Contraindications Unstable bony structuresPatient discomfort
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