Transcript lecture 20 modalities

Therapeutic exercises and
modalities
Lecture 20
The ultimate goal of rehabilitation is to
return the injured athlete to activity, pain
free and fully functional.
 Therapeutic modalities, exercise and
medications are used to create an optimal
environment for injury repair
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Controlling Inflammation
primary goal is to control inflammation by
limiting hemorrhage, edema, muscle
spasm and pain
 PIER
 maintain ROM , strength, flexibility and
CV endurance in unaffected body parts
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Restoration of Motion
goal here is to restore range of motion ,
flexibility to 80 % of unaffected limb
 begin strengthening exercises
 begin proprioceptive work
 maintain other areas
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Flexibility
 Static – movement slow and deliberate
 muscle stretched to point of mild tension
and maintained for a time period
 Ballistic – repetitive bouncing
 may carry joint past point of comfort
 not advisable to do
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Developing Muscular
Strength , Power and
Endurance
focuses on developing muscular
strength, endurance and power
 restore full ROM and proprioception
 initiate sport specific activity – on a
controlled level
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Strengthening
isometric contraction
muscle is at a constant tension
muscle length and joint angle remain the same
Isotonic contraction
muscle contraction generated a force to move
a constant load through a ROM at a variable
speed
free weights , tubing
allows for both concentric and eccentric
strengthening
Isokinetic contraction
 accommodating resistance
 muscular overload and angular movement
to rotate a lever arm at a controlled
velocity
 Cybex, Kin Con
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Open vs Closed Chain Exercises
 open or non weight bearing exercises are
exercises in which the distal joints function
independently of other joints
 greater potential for joint shear
 eg. quad extension machine , hamstring
curls
 closed or weight bearing exercises are
ones in which movement at one joint will
produce predictable motion at another joint
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multiple joints are exercised through
weight bearing
 velocity and torque are more controlled
 shear forces are reduced
 proprioceptors better trained
 eg. squats
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Return to Sport
continue to improve strength , endurance
and power
 restore co-ordination and balance
 improve CV endurance
 analyse skill performance and correct
 increase sport related activities
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Therapeutic Modalities
Indication
 a condition that could benefit from a
specific action or modality
 Contraindication
 a condition adversely affected by a
specific action or modality
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Modalities may be indicated or
contraindicated for the same condition ,
depending on the phase of the therapy
Categories of Modalities
Cryotherapy
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umbrella term that describes a multiple number
of cold therapies
Primarily induces vasoconsctriction
immediate response to cold is a decrease in
circulation and cell metabolism
cold can penetrate 1- 5 cms this does depend
on subcutaneous insulation, temperature and
duration of application
usually applied for 15 to 30 minutes , may
be applied hourly during the first 24 to72
hours
 ice, ice massage, ice tubs, cold whirlpools
, gel packs , chemical packs , vapocoolant sprays
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Magnitude of temperature change
depends on;
 Type of cooling agent
 Temperature difference between the cold
object and the tissue
 Amount of subcutaneous insulation (fat)
 Thermal conductivity of the area being
cooled
 Limb circumference
 Duration of application
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15-26
Thermotherapy
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or heat application
usually used after the acute phase to
increase blood flow and promote healing
heat has an analgesic or sedative effect, it
is used to decrease muscle spasm and
pain
vasodilatation and increased circulation
result in a influx of oxygen and nutrients to
help promote healing
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depth of penetration is generally 2 cm warm whirlpools, hot pack , hot rubs ,
ultrasound
Electric modalities
electrical current refers to a string of
electrons that pass along a conductor
such as a wire.
 depending on the electrical current
parameters, you may be able to affect
sensory , motor or pain fibres
 used to relieve pain , reduce swelling,
muscle spasm, increase blood flow
muscle strength , re-educate muscle
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TENS – used to produce analgesia and
decrease acute and chronic pain
 thought to work on gate therapy –
overriding pain signals
 or to stimulate release of endorphins
 EMS – used to re-educate , increase
muscular strength , reduce muscle spasm
 IFC- used to decrease pain , muscle
spasm and swelling helps increase
circulation and wound healing
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15-14
Massage
 soft tissue massage is a good means to
increase cutaneous circulation , cell
metabolism , venous and lymphatic flow in
the removal of edema, stretch scar tissue
15-15
Ultrasound
high frequency sound waves ( beyond the
range of the human ear) to elicit thermal
and non thermal effects in deep tissue
 Chronic use- thermal effects elevate
temperature and increase collagen tissue
extensibility , blood flow and nerve
conduction, as well as reduce muscle
spasm, joint stiffness and pain
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Acute injuries- nonthermal effects increase
cell membrane permeability, tissue
regeneration , protein synthesis and
reduce edema
 depth of penetration depends on
frequency of the sound head
 most common sound head is 1 MHz = 1
million cycles per sec
 3.0 MHz more superficial
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