Transcript ch 15

Chapter 15: Using
Therapeutic Modalities
© 2011 McGraw-Hill Higher Education. All rights reserved
 Therapeutic modalities can be an effective adjunct to
various techniques of therapeutic exercise
 Knowledge of the healing process is critical
 A variety of modalities can be utilized by athletic
trainers including cryotherapy, electrical stimulation,
ultrasound, massage, traction, diathermy, lasers and
magnets
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Classification of Therapeutic
Modalities
 Electromagnetic
 Includes cryotherapy, thermotherapy, electrical
stimulating currents, diathermy and lasers
 Rely on electromagnetic energy, which travels at the
speed of light
 Energy travels in a straight line
 The energy can be absorbed, refracted, reflected or
transmitted
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 Acoustic
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Ultrasound utilizes acoustic energy
High frequency sound waves
Relies on molecular collisions for energy transfer
Vibration of tissue produces heat and impacts cell
membrane permeability
 Mechanical
 Traction, intermittent compression, massage
 Involves mechanically stretching, compressing and
manipulating soft tissue and joint structures
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Electromagnetic Modalities
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Thermotherapy
 Physiological Effects of Heat
 Dependent on type of heat energy applied, intensity of
energy, duration of exposure and tissue response
 Heat must be absorbed to increase molecular activity
 Desired effects
 Increase collagen extensibility; decreasing joint stiffness;
reducing pain; relieving muscle spasm; reduction of edema
and swelling; increasing blood flow
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 Extensibility of collagen
 Permits increases in extensibility through stretching
 Pain relief
 Activates gate control mechanism
 Muscle spasm
 Increased blood flow reduces ischemia
 Assistance w/ healing process
 Raises tissue temperature, increases metabolism resulting in
reduction of oxygen tension, lowering pH, increasing capillary
permeability and releasing bradykinins and histamine resulting
in vasodilation
 Parasympathetic impulses stimulated by heat are also
believed to be a reason for vasodilation
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 Superficial Heat
 Form of electromagnetic energy (infrared region of
spectrum)
 Increases subcutaneous temperature, indirectly
spreading to deeper tissue
 Muscle temperature increases through reflexive effect
of circulation through conduction
 Moist heat versus dry heat?
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Transmission of Thermal Energy
 Conduction
 Heat is transferred from a warmer object to a cooler one
 Dependent on temperature and exposure time
 Temperatures of 116.6o F will cause tissue damage and
temperatures of 113o F should not be in contact w/ the skin
longer than 30 minutes
 Examples include moist hot packs, paraffin wax, ice packs
and cold packs
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 Convection
 Transfer of heat through movement of fluids or gases
 Temperature, speed of movement, and conductivity of
part impact heating
 Example: Whirlpools
 Radiation
 Heating is transferred from one object through space to
another object
 Shortwave diathermy, infrared heating and ultraviolet
therapy
 Conversion
 Generation of heat from another object
 Example: sound, electricity or chemical agents
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Hydrocollator Packs
 Equipment
 Silicate gel or clay pads
submersed in 160-170o F
water
 Maintains heat for 10-20
minutes
Figure 15-1
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 Indications
 Used for general muscle relaxation and reduction
of pain-spasm-ischemia-hypoxia-pain cycle
 Limitation - unable to heat deeper tissues
effectively
 Application
 Pack removed from water; covered w/ 6 layers of
toweling which are removed as cooling occurs;
area treated for 15-20 minutes
 Athlete must be comfortable and should not lay on
pack
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 Whirlpool Bath
 Equipment
 Varying sizes used to treat a variety of body parts
 Tank w/ turbine that regulates flow
 Agitation (amount of movement) is controlled by air emitted
 Indications
 Combination of massage and water immersion
 Provides conduction and convection
 Swelling, muscle spasm and pain
 Application
 Temperature is set according to treatment goals
 Athlete should be set up to be reached by agitator (8-12” from
agitator)
 Do not place directly on injured site
 Maximum treatment time for acute injuries should not exceed 20
minutes
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 Special Considerations
 Must be careful with fullbody immersion
 Proper maintenance is
necessary to avoid
infection
 As volume of body part
immersion increases,
temperature should
decrease
 Safety is a major concern
 Electrical outlets
 Athlete should not turn
whirlpool on or off
 Contraindicated for acute
injuries due to gravity
dependent position
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Figure 15-2
 Paraffin Bath
 Equipment
 A paraffin wax and mineral oil combination, heated to 126-130o F,
plastic bags, paper towels and towels
 Indications
 Useful in treating chronic injuries
 Effective for angular areas of body such as hands, wrists, elbows,
ankles and feet
 Application
 Body part is cleaned and dried
 Dip and wrap technique
 Hand dipped 6-12 times, wrapped in a plastic bag and then draped w/
a towel to maintain heat for 30 minutes
 Soak technique
 Body part remains in wax 20-30 minutes w/out moving it
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 Fluidotherapy
 Equipment
 Unit which contains cellulose particles through which warm air is
circulated
 Allows for high heating (higher than water and paraffin)
 Indications
 Used to treat distal extremities in effort to decrease pain, increase
ROM and decrease swelling and spasm
 Application
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Temperature ranges from 100-113o F
Particle agitation should be controlled for comfort
Patient should be comfortable
Treatment time = 15-20 minutes
Exercise can be performed while in cabinet
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Figure 15-3
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Figure 15-4
 Special Consideration w/ Superficial Heat
 Important contraindications
 Never apply heat when there is loss of sensation
 Never apply heat immediately after injury
 Never apply heat when there is decreased arterial
circulation
 Never apply heat directly to eyes or the genitals
 Never heat the abdomen during pregnancy
 Never apply heat to a body part that exhibits signs of
acute inflammation
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Cryotherapy
 Used in first aid treatment of trauma to the
musculoskeletal system
 When applied intermittently w/ compression, rest and
elevation it reduces many adverse conditions related to
inflammation and the reactive phase of an acute injury
 RICE (rest, ice compression, elevation) may be used for
the initial days of and injury and continue up to 2 weeks
after injury
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 Physiological Effects of Cold
 Type of electromagnetic energy (infrared radiation)
 Relies on conduction -- degree of cooling depends on the
medium, length of exposure and conductivity
 At a temperature of 38.3oF, muscle temperature can be reduced as
deep as 4cm
 Tissue w/ a high water content is an excellent conductor
 Most common means of cold therapy are ice packs and ice
immersion
 Wet ice is a more effective coolant due to the energy required to
melt ice
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 Vasoconstriction
 Reflex action of smooth muscle due to sympathetic nervous
system and adrenal medulla
 Hunting response
 Intermittent period of vasodilation will occur if cooling
continues for >20 minutes
 Blood viscosity will also increase with extended
cooling
 Decreases extent of hypoxic injury to cells
 Decreases cell metabolic rate and the need for oxygen through
circulation, resulting in less tissue damage
 Decreased metabolic rate and vasoconstriction decreases
swelling associated w/ inflammatory response
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 Decreases muscle spasm
 Muscle becomes more amenable to stretch as a result of
decreased GTO and muscle spindle activity
 Decreases free nerve ending and peripheral nerve
excitability
 Analgesia caused by raising nerve threshold
 Cold is more penetrating than heat
 Ability to decrease muscle fatigue and increase and
maintain muscular contraction
 Attributed to the decrease of local metabolic rates and
tissue temperature
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 Ice Massage
 Equipment
 Foam cup with frozen water - creating a cylinder of ice
(towel will be required to absorb water)
 Indications
 Used over small muscle areas (tendons, belly of
muscle, bursa, trigger points)
 Application
 Ice is rubbed over skin in overlapping circles (10-15 cm
diameters) for 5-10 minutes
 Patient should experience sensations of cold, burning,
aching, & numbness --when analgesia is reached
athlete can engage in rehab activities
 Special considerations
 Keep in mind comfort of the athlete during treatment
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Figure 15-5
 Cold or Ice Water Immersion
 Equipment
 Variety of basins or containers can be used, small whirlpool
 Temperature should be 50-60 degrees F
 Indications
 Circumferential cooling of a body part
 Application
 Patient immerses body part in water and goes through four
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stages of cold response
Treatment may last 10-15 minutes
Once numb, body part can be removed from immersion and
ROM exercise can be performed
As pain returns re-immersion should take place
Cycle can be repeated 3 times
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 Cold or Ice Water Immersion (continued)
 Special Considerations
 Cold treatment makes collagen brittle -- must be cautious
with return to activity following icing
 Be aware of allergic reactions and overcooling
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 Ice Packs (Bags)
 Equipment
 Wet ice (flaked ice in wet towel)
 Crushed or chipped ice in self sealing bag
 Not as efficient, but less messy
 Useful for approximately 15-20 minutes
 Towel should be placed between skin and pack
 Chemical Cold packs
 Gel pack
 Liquid pack
 Indications
 Athlete experiences four stages of cooling and
then proceeds with ROM exercises
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 Special Considerations
 Avoid excessive cold
exposure
 With any indication of
allergy or abnormal pain,
treatment should be
stopped
 When using gel packs, a
single layer of toweling
should be used
 Crushed or flaked ice can
be directly applied to skin
Figure 15-6
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 Vapocoolant Sprays
 Equipment
 Fluori-methane - non-flammable substance that is
released in fine spray from pressurized canister
 Indications
 Reduces muscle spasm, increases ROM, effective on
trigger point
 Application
 For spasm and ROM
 Hold can 12-18 inches from skin, treat entire length of muscle
- covering an area 4 inches/second
 Apply spray 2-3 times, while gradually applying a stretch
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 Vapocoolant Spray (continued)
 Application
 For trigger points
 Locate trigger point
 Position athlete in relaxed position; place muscle on
stretch; apply spray in specific region and over the length of
the muscle
 Apply passive stretch while spraying
 After first session, heat area and then repeat if necessary
 When stretch is complete, have athlete move limb
throughout ROM; but do not overload
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Figure 15-7
 Cryokinetics
 Technique that combines cryotherapy with exercise
 Goal is to numb region to point of analgesia and work
towards achieving normal ROM
 Equipment
 Treat area with ice pack, massage or immersion
 Application
 When analgesia is experienced, exercises should be
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performed (window will last 4-5 minutes)
As pain returns, process may be repeated
Sequence can be repeated 5 times
Exercises should be pain free
Changes in intensity should be limited by both healing and
patient’s perception of pain
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 Special Considerations for Cryotherapy
 Cooling for an hour at 15.8o - 30.2o F produces redness
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and edema that lasts for 24 hours post exposure
Immersion at 41oF increases limb fluid volume by 15%
Exposure for 90 minutes at 57.2o - 60.8o F can delay
resolution of swelling up to one week
Some individuals are allergic to cold and react w/ hives
and joint pain
Icing through a towel or bandage limits the reduction in
temperature -- could limit effectiveness of treatment
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 Special medical conditions
 Raynaud’s phenomenon
 Paroxysmal cold hemoglobinuria
 Application of ice (very rare) can cause nerve palsy
 Motor nerves close to skin overexposed to cold (peroneal
nerve at head of fibula)
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Electrical Stimulating Currents
 Physical Properties of Electricity
 Electricity displays magnetic, chemical, mechanical, and
thermal effects on tissue
 Volume of current (ampere)
 Rate of flow of 1 amp = 1 coulomb
 Resistance = ohms
 Force that current moves along = voltage
 Electricity is applied to nerve tissue at certain intensities and
duration to reach tissue excitability thresholds resulting in
membrane depolarization
 Target sensory, motor, and pain nerve fibers in an effort to
produce specific physiological effects
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 Equipment
 Three types of units
 TENS - transcutaneous electrical nerve stimulators
 NMES/EMS - neuromuscular electrical stimulators or
electrical muscle stimulators
 MENS/LIS - microcurrent electrical nerve stimulators or
low-intensity stimulators
 Generate 3 types of current
 Monophasic
 Direct current or galvanic current - flow in one direction only
from (+) to (-) or vice versa
 Used to produce muscle contraction, pain modulation, ion
movement (determined by specific parameters)
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Figure 15-8
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 Biphasic
 Alternating current where direction of flow reverses during
each cycle
 Useful in pain modulation and muscle contractions
 Pulsatile
 Pulsed currents usually contain three or more pulses grouped
together
 Generally interrupted for short periods of time and repeat
themselves at regular intervals
 Used in interferential and so-called Russian currents
 Current Parameters
 Waveforms
 Different generators have differing abilities relative to the
production of various waveforms
 A graphical representation of shape, direction, amplitude
and direction of current
 Can be sine, square or triangular in shape
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Figure 15-9
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Figure 15-10
 Modulation
 Ability of stim unit to change or alter the magnitude
and duration of a waveform
 May be continuous, interrupted or surged for both AC
and DC currents
 Intensity
 Voltage output of stimulating unit
 High and low voltage units
 Duration (pulse width or pulse duration)
 Refers to the length of time that current is flowing
 Pre-set on most high voltage DC units
 Frequency
 Number of waveform cycles per second
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 Polarity
 Direction of flow -- either positive or negative
 Electrode Set-up
 Use of moist electrodes fixed to the skin
 Can include monopolar (active and dispersive pad) or
bipolar set-up
 Current generally felt under and between both pads
unless monopolar set-up is used --then current is felt
under the smaller active pad
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 Indications
 Pain Modulation
 Gate Control
 Intensity should produce tingling w/out a muscular contraction
 High frequency and pulse duration
 Descending Pain Control
 High current intensity approaching noxious
 Pulse duration of 10 msec; frequency should be 80 pps
 Opiate Pain Control Theory
 Point stimulator should be used with current intensity set as
tolerable
 Pulse duration should be at maximum; w/ a frequency of 1-5
pps
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 Muscle Contraction
 Quality of contraction will change according to current
parameters
 Increased frequency results in increased tension (50pps
results in tetany)
 Increased intensity spreads current over larger area
 Increased current duration causes more motor unit activation
 Muscle pump
 Used to stimulate circulation
 High-volt, DC stimulator; 20-40 pps; surge mode (on/off 5
seconds each; elevation w/ active contraction
 Treatment time 20-30 minutes
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 Muscle strengthening
 High frequency AC current; 50-60 pps; 10:50
seconds on/off ratio; 10 repetitions 3x per
week; perform with active contractions
 Retardation of atrophy
 High frequency AC current 30-60 pps; w/
voluntary muscle contraction encouraged; 1520 minutes
 Muscle re-education
 Level of comfortable contraction -- 30-50 pps;
w/ either interrupted or surge current
 Athlete should attempt to contract muscle
along w/ stim
 Treatment time 15-20 minutes and repeated
multiple times over the course of a week
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 Types of Settings
 Iontophoresis
 Introduction of ions into body tissue via direct electrical
current
 Equipment
 Iontophoresis generator which produces a continuous
monophasic current
 Indications
 Used to treat musculoskeletal inflammatory conditions,
analgesic effects, scar modification, wound healing,
calcium deposits, hyperhidrosis
 Medication
 Dexamethasone and hydrocortisone are two commonly
used
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 Application
 Reusable or commercially produced electrodes
 Three application techniques
 Active pad over medication saturate gauze
 Body part and active electrode submerged in tub of ion solution
 Special active electrode with medication reservoir
 Utilize large dispersive pad
 Movement of positively and negatively charged ions
relative to electrode charges (poles)
 Treatment last 10-20 minutes depending on current
intensity and ion concentrations in solution
 Requires use of low voltage direct current on continuous
mode w/ a long pulse duration (allows for migration of
ions)
 Must be careful to avoid chemical burns and certain to
utilize appropriate medications for specific conditions
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 Interferential Currents
 Equipment
 Uses 2 separate generators, emitting current at
slightly different frequencies
 Quad polar pad placement is used, creating
interference pattern
 Creates a broader area of stimulation
 Indications
 Pain control (including joints), swelling, neuritis, retardation
of callus formation following fracture & restricted mobility
 Application
 Pads must be placed to ensure that current is centered
over painful area
 Similar treatment parameters can be used
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 Low Intensity Stimulators
 Equipment
 Micro-current electrical nerve stimulator
 Operates at low frequencies and intensities (sub-sensory)
 Indications
 Used to stimulate healing of soft tissue and bone
 Modulate pain, promote wound healing, promote non-union
fracture healing, tendon and ligament healing
 Based on theory, little research support
 Application
 Utilizes same electrical currents as previously described
 Using large dispersive pad maintains current density at
thresholds which will not result in sensory nerve depolarization
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Ultrasound Therapy
 Modality which stimulates repair of soft tissue and
pain relief
 Form of acoustic energy used for deep tissue heating
 Operates at inaudible frequency
 Sound scatters and is absorbed as it penetrates tissues
-- losing energy = attenuation
 Impedance and penetration are determined by
properties of media (densities)
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 Equipment
 High frequency generator which provides
electrical current through a coaxial cable to a
transducer applicator
 Through piezoelectric effect electrical current
is transformed into acoustic energy through
contraction and expansion of piezoelectric
crystals
 Frequency ranges between .75 and 3.0 MHz
 1 MHz ultrasound allows for deeper penetration
while 3 MHz is absorbed more superficially
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 Area of transducer that
produces sound is the
effective radiating area
 Produces a beam of acoustic
energy - collimated cylindrical
beam with non-uniform
distribution
 Variability in the beam (beam nonuniformity ratio - BNR) =lower
BNR = more uniform energy
output
 Intensity is determined by
amount of energy delivered to
the sound head (W/cm2)
 Can be delivered as either
pulsed or continuous
ultrasound
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Figure 15-14
 Indications
 Produces thermal and non-thermal effects
 Generally used for tissue heating (must increase tissue temp
between 104o and 113oF
 Non-thermal effects include microstreaming and cavitation
which impacts tissue permeability and fluid movement - useful
with acute injuries
 For solely non-thermal effects, intensity must remain below .2
W/cm2
 Frequency resonance hypothesis relates to alterations in protein
signaling frequency which impact permeability, healing and protein
production
 Acute conditions require more treatments over a shorter
period and chronic conditions require fewer treatments
over a longer period
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 Application
 Direct skin application
 Requires a coupling medium to provide airtight contact w/
skin and a low friction surface
 Underwater application
 Used for irregularly shaped structures
 Body part is submerged in water, ultrasound head is
placed 1” from surface
 Water serves as coupling medium, air bubbles should be
continually swept away
 Sound head should be moved in circular or longitudinal
pattern
 Should be performed in non-metal container to avoid
reflection
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 Gel pad technique
 Used when body part can not be immersed in water
 Gel pad applied to treatment area
 Coated with gel to enhance contact surface
 Moving the transducer
 Leads to more even distribution of energy, reducing
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likelihood of hot spots
Should be moved at a rate of 4cm/second
Must maintain contact of transducer with surface of skin
Circular or stroking patterns should be used
Should not treat an area larger than 3 times the ERA
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 Dosage and Time
 Varies according to depth of tissue to be treated and the
state of injury
 Duration tends to last 5-10 minutes
 Intensity varies
 Low 0.1-0.3 W/cm2
 Medium 0.4 - 1.5 W/cm2
 High 1.5 - 3.0 W/cm2
 Special Considerations
 While it is a relatively safe modality, precautions still must
be taken
 Be careful with anesthetized areas, reduced circulation
 Avoid high fluid regions of the body, acute injuries, and
epiphyseal areas of children
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Ultrasound in Combination
w/ Other Modalities
 Ultrasound can be used w/ a variety of modalities to
accomplish a series of treatment goals
 Use of hot packs with ultrasound may have an additive
effect on muscle temperature
 Cold packs, while often used in conjunction with
ultrasound, may interfere with heating
 With electrical stimulation, it is often useful for trigger
point treatment (blood flow, muscle contraction and
pain modulation)
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Figure 15-15
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Phonophoresis
 Method of driving molecules through the skin
using mechanical vibration
 Process which moves medication to injured tissues
 Indications
 Primarily used to drive hydrocortisone and anesthetics into
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the tissue
Used on trigger points, tendinitis and bursitis
Effectiveness of treatments is still being explored
Generally involves the use of a 10% hydrocortisone ointment
(rubbed into the area), followed by application of coupling
medium and ultrasound treatment
Chem pads are also available
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Mechanical Modalities
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Traction
 Drawing tension applied to a body segment
 Physiological Effects
 Produces separation of vertebral bodies impacting
ligaments, capsules, paraspinal muscles; increases
articular facet separation, and relief of nerve root pain;
decreases central pressure of vertebral disks;
increases proprioceptive changes; relief of joint
compression due to normal posture
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 Indications
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Spinal nerve root impingement
Decrease muscle guarding, treat muscle strain
Treat sprain of spinal ligaments
Relax discomfort from normal spinal compression
 Application
 Manual and traction machines can be used
 Manual
 Adaptable and allows for great flexibility
 Changes in force, direction, duration and patient positioning
can be made instantaneously
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 Mechanical Traction
 Can be used to apply cervical or lumbar traction
 Positional Traction
 Used on trial and error basis to determine maximum position of
comfort to accomplish specific goal
 Wall-Mounted Traction
 Cervical traction can be accomplished w/ this unit
 Involves use of plates, sand bags or water bags for weight
 Relatively inexpensive and effective
 Inverted Traction
 Utilizes special equipment or simply inverting ones self
 Weight of trunk lengthens spine, providing a stretch
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Figure 15-17
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Figure 15-19
Figure 15-16
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Figure 15-18
Intermittent Compression
Units
 Equipment
 Utilizes nylon inflatable sleeve
 Sleeve is inflated to specific pressure using either water
or air
 Utilized to facilitate movement of lymphatic fluids
 Parameters
 Able to adjust on/off time, pressure and treatment time
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 Indications
 Used for controlling or reducing
swelling after acute injury
 Good for pitting edema, which
develops several hours after injury
 Elevation of extremity is critical to
effective treatment
 With electrical stimulation, muscle
pumping can be incorporated to
facilitate lymphatic flow
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Figure 15-20
 On/Off Time
 Will often vary (1:2, 2:1, or 4:1)
 Not research based
 Pressures
 Must be mindful of blood pressure
 Upper extremity 30-50 mm Hg
 Lower extremity 30-60 mm Hg
 Some units allow for combining cold along with
compression
 Electric stim can also be combined during some
treatments
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 Cryo-Cuff
 Uses both compression
and cold simultaneously
 Elevation of cooler results
in increased cuff pressure
 Also allows for circulation
of cooler water
 Portable and easy to use
 Game Ready System
 Circulates water with
compression
 Can be customized for
various time, temperature
and compression settings
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Figure 15-21
Massage
 Systematic manipulation of soft tissue
 Therapeutic Effects
 Mechanical Responses
 Occur as a direct result of pressures and movements
 Encourages venous flow and mild stretching of superficial tissue
 Physiological Responses
 Increases circulation aiding circulation, removal of metabolites,
overcoming venostasis
 Reflex effect - response to nerve impulses initiated through
superficial contact
 Impacts body relaxation, stimulation, and increased circulation
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 Relaxation can be induced by slow superficial stroking of
skin
 Stimulation achieved by quick brisk strokes, causing
contraction of tissue
 Primarily psychological impacts
 Increased circulation through reflexive and mechanical
stimuli
 Capillary dilation, stimulation of cell metabolism, decreasing
toxins and increase lymphatic and venous circulation
 Psychological Responses
 Tactile system is one of the most sensitive systems of the
body
 Because the laying on of hands is used w/ massage it can
be an important means of creating a bond of confidence
between the athlete and the clinician
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Application
 Effleurage
 Stroking divided into
light and deep
 Can be used as a
sedative or to move
fluids
 Multiple stroking
variations exist
 Pressure variations
Figure 15-22
Figure 15-23
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 Petrissage
 Kneading
 Involves picking up
skin between thumb
and forefinger, rolling
and twisting in
opposite directions
 Used for deep tissue
work
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Figure 15-25
 Friction
 Used around joints and in areas where tissue is thin
 Areas w/ underlying scarring, adhesions, spasms
and fascia
 Goal is to stretch underlying tissue, develop friction
and increase circulation
Figure 15-26
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 Tapotement
 Cupping
 Produces invigorating and stimulating sensation
 Series of percussion movements rapidly duplicated at a
constant tempo
 Hacking
 Used to treat heavy muscle areas, similar to cupping
 Pincing
 Lifting of small amounts of tissue between thumb and first
finger in quick, gentle pinching movements
 Vibration
 Rapid movement that produces quivering or trembling
effect to tissue
 Used to relax and soothe
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Figure 15-27
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 Special Considerations
 Make the patient comfortable
 Positioning, padding, temperature, privacy
 Develop confident, gentle approach to massage
 Good body positioning (clinician and athlete) an develop
good technique
 Stroke towards heart to enhance lymphatic and venous
drainage
 Know when to avoid massage
 Acute conditions, skin conditions, areas where clots can
become dislodged
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 Sports Massage
 Usually confined to a specific area - rarely given to
full body
 Full body massage is time consuming, generally
not feasible
 Five minute treatment can be effective
 Massage lubricants
 Enables hands to slide and move easily over body, reducing
friction
 Rubbing dry area can irritate skin
 Mediums include powder, lotion, oil or liniments
 Positioning of Athlete
 Area must be easily accessible and must be relaxed
 Exhibit Confidence
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 Ensure Patient Privacy and Athletic Trainer Integrity
 Due to direct physical contact professionalism must be
maintained at all times
 Critical when dealing with patient of opposite sex
 Be sure that area being treated is the only area
exposed
 An additional athlete or athletic trainer should also be
present
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 Deep Transverse Friction Massage
 Transverse or Cyriax method used to treat muscle,





tendon, ligaments and joint capsules
Goal is mobilization of soft tissue
Generally precedes activity
Movement is across the grain of the affected tissue
Avoid treatment with acute injuries
Treatment will produce numbing effect allowing for
exercise mobilization
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 Acupressure Massage
 Based on Chinese art of acupuncture
 Physiological explanation and effectiveness may be
based on pain modulation mechanisms
 Clinician can utilize acupuncture points in treatment
 Locate through measurement of electrical impedance
or palpation
 Small circular motions are used to treat points
(pressure to tolerance of athlete = generally more
pressure = more effective treatment)
 Treatment time ranges from 1-5 minutes
 Can treat one or more points, working distal to
proximal
 Will produce dulling or numbing sensation w/ results
lasting from minutes to hours
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Magnet Therapy
 Becoming popular amongst competitive
and recreational athletes
 Used in cases of musculoskeletal ailments
 Limited research on magnetic therapy
 Utilizes magnetic fields to physiologically
impact body
 Change polarity of damaged cells, increase blood flow,
increase muscle strength and hormone secretion,
increase cell division and enzyme activity, increase
lymphatic flow and alter blood pH
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Recording Therapeutic
Modality Treatments
 Specifics of treatment should be recorded on original
SOAP note, progress note and treatment log
 Changes in treatment parameters and modalities should
always be noted
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Safety in Using Therapeutic
Modalities
 Equipment must be used and maintained in appropriate
manner
 Following manufacturer recommendations
 Regarding use and maintenance
 Failure to follow recommendations = negligence
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Regarding Therapeutic
Modality Use
 Clinical effectiveness has yet to be established for a
variety of conditions
 Often rely on efficacy generated by manufacturers
rather than research
 Minimal modality-related evidence-based information
available
 Evidence should be carefully questioned and considered
 Best evidence should be put into practice
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