Transcript Athletic Training

Athletic Training
Modalities 2
Modalities: Thermotherapy
• Types of Thermotherapy:
– Moist Heat:
• Whirlpool Bath
– A combination of massage and water immersion
– A popular thermotherapy used in sportsmedicine.
Modalities: Thermotherapy
– Moist Heat: Whirlpool Bath
• Equipment (Tanks)
– Extremity
• 15”(wide)x32”(long)x18”-25” (deep)
• Legs and arms
– Low-Boy
• 24”(wide)x62”(long)x18”(deep)
• Full body immersion
• Lower to the floor
– High-Boy
• 24”(wide)x32”-48”(long)x28” (deep)
• Hip or Leg
Modalities: Thermotherapy
• Moist Heat: Whirlpool Bath (2)
– Equipment (2)
• Tank with Turbine Motor
– Regulates the air and water movement
– Amount of movement (agitation) is controlled by the
amount of air is emitted (more air/more water movement)
– Turbine can be moved up and down, rotated, or locked in
place.
– Indications
• Provides both conduction (Skin contacting the
water) and convection (water swirling around skin)
Modalities: Thermotherapy
• Moist Heat: Whirlpool Bath (2)
– Indications (2)
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Reduce swelling
Reduce muscle spasm
Reduce pain
Active movement of the body part (buoyancy of
water)
Modalities: Thermotherapy
• Moist Heat: Whirlpool Bath (3)
– Application
• Set the Water Temperature
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Very Cold
Cold
Tepid
Neutral
Warm
Hot
Less than 55
55-65
80-90
92-96
96-98
98-104
– Acute Injuries:
Very cold-Cold
– Chronic Injuries: Tepid-Hot
Modalities: Thermotherapy
• Moist Heat: Whirlpool Bath (4)
– Applications (2)
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Fill the tank w/water
Have athlete get in a comfortable position
Place the water jet 8”-10” from the injury
Acute injuries: do not to let the water jet hit directly
on the injury if it causes pain.
• Time:
– Acute injuries: no more than 20 minutes
– Chronic: 20-30 minutes
Modalities: Thermotherapy
• Moist Heat: Whirlpool Bath (5)
– Special Considerations:
• Full body immersion may cause dizziness
• Care needs to be taken to prevent the spread of infection
– Empty tank after each use
– Disinfectant (scrub)
– Rinse with clean water
• Safety
– Ground Fault Circuit Interrupters (GFCI)
– Athlete is not to turn whirlpool on or off while in the water
– Preferred that the on/off switch be away from the whirlpool
Modalities: Thermotherapy
• Moist Heat: Paraffin Bath
– Equipment
• Commercial Paraffin Bath Unit maintains the
Paraffin/Mineral Oil mixture at a temperature of
126-130 degrees. The mineral oil lowers the
melting point of the paraffin thus allowing the skin
to tolerate the higher temperature w/o burning the
skin.
• Slats in the bottom to protect the athlete from
burns & collect settling dirt.
• Paper or plastic bags
• Towels
Modalities: Thermotherapy
• Moist Heat: Paraffin Bath (2)
– Indications
• Appling heat to distal extremities
• Good for chronic injuries
• Angular body parts (hands, wrist, elbows, ankles
and feet)
– Application
• Thoroughly clean (wash) and dry the body part
Modalities: Thermotherapy
• Moist Heat: Paraffin Bath (3)
– Application (2)
• Dip Method
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Dip affected part into the paraffin bath and pull it out
Let paraffin harden slightly
Repeat 6-10 times.
After the last dip let the wax harden then place in a
plastic bag
– Wrap toweling around the plastic bag
– After finishing the treatment remove the paraffin and
place it back into the Paraffin Bath.
Modalities: Thermotherapy
• Moist Heat: Paraffin Bath (4)
– Application (3)
• Soak Method
– After dipping the body part into the paraffin bath the
athlete leaves it in there for 15-20 minutes w/o moving it.
– After finishing the treatment remove from the paraffin and
after the paraffin hardens, place it back into the Paraffin
Bath.
Modalities: Thermotherapy
• Deep Heat
– Therapeutic Ultrasound
• The most commonly used deep heat modality in sports
medicine
• Uses high frequency sound waves beyond the audible range
• Heat is produced by conversion type modality
• Sound energy causes molecules in the tissue to vibrate and
thus producing heat and mechanical energy
• Frequency of sound waves: # of oscillations
(movements)/second
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (2)
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Hertz (Hz): 1Hz = 1 cycle/second
1kHz = 1000 cycles/second
1mHz = 1,000,000 cycles/second
The human ear can not detect sounds greater than 20,000 Hz
1mHz is the frequency most commonly used in ultrasound
therapy
– The amount of tissue penetration that Ultrasound Therapy will
penetrate tissue depends on the type of tissue, tissue density,
amount of reflection, scattering and absorption.
– The greatest heat is produced between the bone and the
adjacent soft tissue
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (3)
– Equipment:
• Therapeutic Ultrasound high frequency generator that
produces electricity to the transducer.
• The transducer head contains a quartz crystal. Quartz has
the property that it can contract and expand. When it
contracts and expands it produces the ultrasonic waves. This
contraction and expansion is called “piezoeelectrical effect”
• The intensity is determined by the amount of energy
(electricity) that is delivered to the crystal that is in the sound
head.
• The intensity is expressed in watts/centimeter squared.
• Therapeutic intensities range from 0.1-3.0 w/cm squared.
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (4)
– Indications
• There are 3 types of therapeutic effects from the
application of ultrasound:
– Thermal Effects
– Mechanical Effects
– Chemical Effects
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (4)
– Indications: Thermal
• Of skin, muscle and fat the greatest heat is created were the
bone/muscle meet (106).
• Joint Capsule heated as high as 117.5
• Nerve tissue is 2x as sensitive to ultrasound than muscle.
• Increase Collagen Tissue extensibility (main organic part of
connective tissue
• Alters blood flow
• Changes nerve conductivity
• Elevates pain threshold
• Raises enzymatic activity
• Changes muscle contractibility
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (5)
– Indications: Mechanical
• Results from mechanical vibrations (micromassage)
• This effect only occurs at very low intensities (.1-.2 w/cm
squared)
– Indications: Chemical
• Accelerates enzymatic activity
• Increases capillary permeability
• Increases ATP activity in skeletal muscle (ATP=Adenosine
Triphosphate: found I all cells& when split energy is
produced, energy of muscle is stored in this compound)
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (6)
– Indications: Other
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Joint contracture
Scar tissue
Chronic Tendonitis
Chronic Bursitis
Skeletal muscle spasm
Pain
Undesirable Calcification
– Bursitis, tendonitis, myositis ossificans, exostosis
– Helps reabsorption of calcium and/or relieves the inflammation
• Planter warts
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (7)
– Application
– Ultrasound waves can not travel through air. Since the
skin can reflect them there must be some type of
coupling medium between the sound head and the skin
• The mediums may be lotion, water soluble gels or
mineral oil.
• Clean the skin prior to any treatment
• Direct Skin: Must have a medium
• Underwater: water is the medium, No air bubbles
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (8)
– Combination with other modalities
• Hydrocollator Packs
• Cryotherapy
• Electrotherapy (EGS)
– Find trigger points
– U.S. increases blood flow while the EGS crates a muscle
contraction to help easy the pain/spasm/pain cycle.
• Phonophoresis
– Method of driving molecules (medication: hyrdocortisone
and anesthetic) through the skin by the use of sound
waves
Modalities: Thermotherapy
• Deep Heat: Therapeutic Ultrasound (9)
– Special Considerations
• Caution must be taken when used over anesthetized areas
(pain is the indicator of over treatment)
• Caution must be taken when used over areas that have a
decrease in circulation
• Do not use over high fluid areas
– Eyes, ears, testes, spinal cord, brain or heart
• Reproductive organs of females
• Acute injuries
• Epiphyseal plates: very little exposure
Modalities: Electrotherapy
• Physical Principles
– Displays: Magnetic, Chemical, Mechanical and
Thermal effects on the body
– Electrical current: a string of electrons that pass along
a conductor or nerve.
– Amperes (amps): measures intensity of the current
– Ohms: Measures the resistance of the passage of the
electrical current
– Voltage: the force that moves the current along
• Low Voltage: 0-150 V
• High Voltage: above 150 V
– Watts (amps x volts): electrical power is measured in
Modalities: Electrotherapy
• Physical Principles (2)
– 2 types of current used in sports medicine
• Alternating Current (AC)
– Reverses its self 1x/cycle
– Used for:
• pain modulation
• Muscle contraction
• Direct Current (DC) {or Galvanic}
– Current flows in one direction(+ to -)
– Used for:
• Pain modulation (Gate control, endogenous opiates)
• Muscle contraction
• Ion movement (iontophoresis: movement of ions through
the skin by the use of electrical current)
Modalities: Electrotherapy
• Types of Direct Current
– Transcutaneous Electrical Nerve Stimulation
(TNS or TENS)
– Electrogalvanic Muscle Stimulation (EGS)
– Electric Muscle Stimulation (EMS)
Modalities: Electrotherapy
– Transcutaneous Electrical Nerve Stimulation
(TNS or TENS)
• Used to block the pain signal between the injury
and the spinal cord
• Stimulates the nerve
Modalities: Electrotherapy
– Electrogalvanic Muscle Stimulation (EGS)
• Stimulates the muscle
• 150 V or higher to achieve the best results
• Can use for:
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Muscle reeducation
Muscle pumping
Muscle strengthening
Atrophy retardation
Iontophoresis
Modalities: Electrotherapy
– Electric Muscle Stimulation (EMS)
• Stimulates the muscle
• 0-150 V
• Can be use for:
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Muscle reeducation
Muscle pumping
Muscle strengthening
Atrophy retardation
Modalities
• Other Treatment Modalities
– Massage
– Acupressure
– Traction
– Intermittent Compression
Modalities
• Massage:
– Definition: Systematic manipulation of the
body
– Types:
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Effleurage:
Petrissage:
Friction:
Tapotement:
Vibration:
stroking
kneading
heat producing
percussion
rapid shaking
Modalities
• Massage (2)
– Mechanical:
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Venous drainage
Lymphatic drainage
Mild stretch of superficial tissue
Stretching and breaking up scar tissue
– Physiological:
• Relaxation
• Stimulation of blood flow
– Psychological:
• Relaxation
Modalities
• Massage (3)
– Sports Massage
• Confined to the specific injury area
– Massage Lubricants
• Powder, oils, lotions
– Confidence
• Must be confident in sports massage
Modalities
• Acupressure
– A type of massage that based on acupuncture
Modalities
• Traction
– Drawing tension applied to a body segment
– Most commonly used on the cervical and lumbar
spine regions
– Physiological Effects:
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Relief of pressure on nerve roots
Decrease pressure on intervertebral disc
Relief of compression effects of normal posture
Relaxation
– Indications:
• Relief of spinal nerve impingement
• Relief of other nerve impingements
Modalities
– Intermittent Compression Devices
– Pneumatic sleeve applied around the injured
extremity with air or water intermittently
applied to the area.
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Used to control swelling
Used to reduce swelling
Used on acute or chronic injuries
Pitting edema
Creates the movement of lymphatic fluid out of the
injured area
• Extremity should be elevated during treatment
Modalities
The End