Transcript Modalities 1 PPT

Athletic Training
Modalities
Modalities: Objectives
• Legal ramifications of treating the athlete with
therapeutic modalities.
• Relationship of therapeutic modalities and
electromagnetic energy.
• Theoretical use of various types of modalities.
• Application of various types of thermotherapy
and cryotherapy techniques.
• The physiological basis and therapeutic uses of
electrical stimulating currents.
• How massage, traction and intermittent
compression can be used as therapeutic agents.
Modalities: Introduction
• Sports medicine and athletic training use a wide
variety of therapeutic modalities.
• The following will be discussed during this unit:
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Legal Concerns
Transmission of Thermal Energy
Cryotherapy
Thermotherapy
Ultrasound
Electrotherapy
Massage
Traction
Intermittent Compression
Modalities: Legal Concerns
• Must be used with great care,
• No indiscriminate use,
• The athletic trainer must follow the laws of their
state on use or restriction of use.
Kentucky Revised Statutes - Chapter 311
www.kbml.ky.gov/ah/at.htm
• The athletic trainer must have a thorough
understanding of the functions, indications of
use and contraindications of each modality
used.
Modalities: Legal Concerns
• The athletic trainer when deciding the
appropriate modality to use the decision
must be based on accurate evaluation of
the injury and which modality will achieve
the most effective treatment result for the
injury being treated.
• Use of the appropriate modality is an
integral part of the treatment and
rehabilitation of the athlete.
Methods of Heat Transfer
– Conduction
• Heating through direct contact
– Convection
• Heating through indirect contact (air or liquid)
– Conversion
• Heating through other forms of energy (ultrasound, electrical)
– Radiation
• Transfer of heat through space from one object to another.
(infrared, UV, heat lamps)
Modalities: Cryotherapy
• Defined as: application of cold
• A well accepted practice in athletic training
• When applied w/compression, elevation
and rest reduces adverse conditions
related to the inflammatory and reactive
phase of an acute injury.
• Cryotherapy can be used for a few days or
for the extent of the injury depending on
the severity.
Modalities: Cryotherapy
• Physical Principles
• A type of electromagnetic energy (infrared
radiation)
• When applied to a warmer object, heat is
abstracted.
• Most common method of cold transfer is
through conduction
Modalities: Cryotherapy
• The extent of tissue being cooled depends on:
– Type of cold medium being applied: Wet ice
penetrates deeper than dry ice.
– Length of cold exposure: the longer cold exposure the
deeper (38 degrees/4cm)
– Conductivity of the tissue being cooled: High water
content more cooling (muscle), Low water content
less cooling (Fat: insulator), the thicker subcutaneous
fat layer the longer it takes to cool.
– Tissue that has been cooled takes longer to return to
normal than heated tissue.
Modalities: Cryotherapy
• Physiological Effects
• Cold applied to skin for 15 minutes @ 50
degrees F, Vasoconstriction occurs.
• Cold applied for greater than 25-30
minutes then the “Hunting’s Response”
occurs: for 4-6 minutes there are periods
of vasodilation & vasoconstriction (spasm).
Modalities: Cryotherapy
• Physiological Effects Continued
• Cold causes:
– an increase in blood viscosity and vasodialators
– Decrease the extent of cell hypoxia less cell damage less
rehabilitation time
– Decrease in new Swelling occurring (metabolic rate)
– Decrease in Muscle Spasm
– Decrease in Pain Perception
– Decrease in Collagen Elasticity
– Increase in Joint Stiffness
– Increase in Capillary Permeability
– Decrease Muscle Fatigue
– Increase in ability to Maintain Muscle Contraction
Modalities: Cryotherapy
• Skins Response to Cold
• 0-3 Minutes:
Cold Sensation
• 2-7 Minutes:
Mild Burning/Aching
• 5-12 Minutes:
Cutaneous Anesthesia
Modalities: Cryotherapy
• Special Considerations:
• Adverse Reactions to therapeutic cold application are
uncommon but sometimes do occur
– Cooling @ 30 degrees for 1 hour: redness and edema that
last for 20 hours or more.
– Frostbite can occur @ subfreezing temperature (24-26
degrees)
– Ice Immersion @ 41 degrees: can increase limb fluid
volume by 15%
– Exposure at 57-61 degrees for 90 minutes can delay the
swelling from reabsorbing for up to 1 week.
– Allergic Reactions: Hives, Joint Pain and Swelling.
Modalities: Cryotherapy
• Special Considerations: Continued
• Raynaund’s Phenomenon: Vasospasm of
the digital arteries lasting for a few minutes
to hours that could lead to tissue death.
• Signs:
– Intermittent skin blanching
– Cyanosis of the fingers or toes
– Redness then back to normal skin color.
Modalities: Cryotherapy
• Special Considerations: Continued
• Paroxysmal Cold Hemoglobinuria:
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Rare, can occur minutes after cold exposure
May lead to renal dysfunction/failure
Secondary hypertension
Early Symptoms:
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Severe pain in the back and legs
Headache
Vomiting
Diarrhea
Dark Brown Urine
Modalities: Cryotherapy
• Special Considerations: Continued
• Nerve Palsy:
– Relatively Uncommon
– Occurs when cold is applied to a body part
that has motor nerves close to the skin
surface.
– The body part goes numb and no movement
until the body part warms
Modalities: Cryotherapy
• Ice Massage
– Equipment:
• Cup filled with water and frozen
• Towel
– Indications: Used over small muscle areas or
a bursa
– Application:
– Special Considerations:
• An athlete with normal circulation: None
• Consider the comfort of the athlete
Modalities: Cryotherapy
• Ice Water Immersion
– Equipment: Depending on the body part;
• A container filled w/water and ice
• Towel
– Indications: Used when circumferential of the body
part is needed.
– Application:
– Special Considerations:
• Protect the toes/fingers from frostbite
• Water needs to be no colder then 45-50 degrees
• Athlete can not return to full performance until rewarmed
Modalities: Cryotherapy
• Ice Packs: Most common type used
– Equipment: Depending on the body part;
• A plastic bag filled with ice
• Commercial Ice Packs (towel)
• Chemical Ice packs
– Indications: Anywhere cooling is needed
– Application:
– Special Considerations:
• Use of wet towel between commercial ice packs and skin
• Watch for chemical burns with chemical ice packs
• Athlete can not return to full performance until rewarmed
Modalities: Cryotherapy
• Vapocoolant Sprays
– Equipment: Fluori-Methane
• Non-flammable and non-toxic
– Indications:
• Acute muscle spasm
• Increase range of motion from muscle spasm
• Acute contusions
– Application:
• Spray and stretch
– Special Considerations:
• Care to prevent frostbite
Modalities: Cryotherapy
• Cryokinetics
– Combines cold therapy with exercise
– Goal:
• Numb the injured body part and work the injured body part to
achieve normal range of motion
• Use progressive active exercise
• Return to full sport activity
– Application:
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Apply cold until the analgesic phase is achieved
Exercise should be pain free (3-5 minutes)
Reapply cold
Repeat process 3-5 times
– Special Considerations:
• If the analgesic phase is not achieved in 20 minutes, continue on
with the exercise phase
• Intensity limited by healing process and pain perception
Modalities: Thermotherapy
• The application of heat has been used for
centuries to treat disease and traumatic
injuries.
• Heat is an energy form the increases
molecular activity.
Modalities: Thermotherapy
• Methods of Heat Transfer:
– Conduction
• Heating through direct contact
– Convection
• Heating through indirect contact (air or liquid)
– Conversion
• Heating through other forms of energy (ultrasound, electrical)
– Radiation
• Transfer of heat through space from one object to another.
(infrared, UV, heat lamps)
Modalities: Thermotherapy
• Physiological Effect of Heat
– The body’s response depends on the type of
heat energy applied, duration, intensity, and
the type of tissue applied to.
– For a physiological effect to occur the heat
energy must be absorbed to cause an
increase in metabolic activity.
– Once the heat energy is absorbed, the heat
will be spread to adjacent tissue.
Modalities: Thermotherapy
• To achieve a therapeutic effect from the
heat the correct amount must be applied:
– To little: no change occurs
– To much: tissue damage
Modalities: Thermotherapy
• Physiological Effects:
– Muscle Spasm:
– Pain Perception:
– Blood Flow:
– Metabolic Rate:
– Collagen Elasticity:
– Joint Stiffness:
– Capillary Permeability:
– Edema:
Decreases
Decreases
Increases
Increases
Increases
Decreases
Increases
Increases
Modalities: Thermotherapy
• Superficial Heat Therapies:
– Usually a safe modality as long as:
• The intensity is kept reasonable
• The application is not to long
– Moist heat will penetrate deeper than dry heat
– Cause vasodilatation that continues for up to
1 hour after its removal.
Modalities: Thermotherapy
• Special Considerations:
– Never apply heat when there is a loss of sensation
– Never apply heat on an Acute injury.
– Never apply heat when there is a decrease in arterial
circulation.
– Never apply heat directly to the eyes.
– Never apply heat directly to the genitals.
– Never heat the abdomen during pregnancy.
– Never apply heat to a body part that exhibits signs of
acute inflammation (swelling, redness, heat).
Modalities: Thermotherapy
• Types of Thermotherapy
– Moist Heat
• Moist Heat Packs (Hydrocollator Packs)
• Whirlpool
• Paraffin Bath
– Deep Heat
• Shortwave/Microwave Diathermy
• Therapeutic Ultrasound
Modalities: Thermotherapy
• Types of Thermotherapy (2)
– Electrotherapy
• Electrical Stimulating Units
– Alternating Current (AC)
– Direct Current (DC)
• Laser (Low Power)
• TENS (Transcutaneous Nerve Stimulation)
– Additional
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Massage
Acupressure/Acupuncture
Traction
Intermittent Compression Devices
Modalities: Thermotherapy
• Types of Thermotherapy:
– Moist Heat:
• Most widely used form of thermotherapy
• Readily available
• A disadvantage of trying to control therapeutic
effects because of the rapid dissipation of heat
which makes maintaining a constant skin
temperature difficult.
Modalities: Thermotherapy
• Types of Thermotherapy:
– Moist Heat:
• Moist Heat Packs (Hydrocollator Packs)
– Heats by conduction
• Equipment:
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Packs contain a silicon gel in a cotton pack
Immersed in hot water (160-170)
Stays hot for 15-30 minutes
Toweling
Modalities: Thermotherapy
• Moist Heat: Hydrocollator Packs (2)
• Indications:
– General relaxation of the body part
– Reduction of the Pain-Spasm-Pain Cycle
• Application:
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Athlete should be in a comfortable position
Remove from the water and the water to drain off
Cover the pack with layers of toweling
Treatment time: 15-30 minutes
As pack cools: remove the toweling layers to continue
heating
Modalities: Thermotherapy
• Moist Heat: Hydrocollator Packs (3)
– Special Considerations:
• Athlete should not lay on the packs
• Make sure the athlete is in a comfortable position
• If athlete feels like it is burning the skin: add more
toweling.