© 2011 mcgraw-hill higher education. all rights reserved chapter 15: using therapeutic modalities
TRANSCRIPT
© 2011 McGraw-Hill Higher Education. All rights reserved
Chapter 15: Using Therapeutic Modalities
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 lasersRely on electromagnetic energy, which travels at the
speed of lightEnergy travels in a straight lineThe energy can be absorbed, refracted, reflected or
transmitted
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AcousticUltrasound utilizes acoustic energyHigh frequency sound wavesRelies on molecular collisions for energy transferVibration of tissue produces heat and impacts cell
membrane permeability
MechanicalTraction, intermittent compression, massage Involves mechanically stretching, compressing and
manipulating soft tissue and joint structures
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© 2011 McGraw-Hill Higher Education. All rights reserved
Electromagnetic Modalities
ThermotherapyPhysiological 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 activityDesired 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 collagenPermits increases in extensibility through stretching
Pain reliefActivates gate control mechanism
Muscle spasmIncreased blood flow reduces ischemia
Assistance w/ healing processRaises 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 HeatForm of electromagnetic energy (infrared region of
spectrum) Increases subcutaneous temperature, indirectly
spreading to deeper tissueMuscle temperature increases through reflexive effect
of circulation through conductionMoist heat versus dry heat?
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Transmission of Thermal EnergyConduction
Heat is transferred from a warmer object to a cooler oneDependent on temperature and exposure timeTemperatures 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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ConvectionTransfer of heat through movement of fluids or gasesTemperature, speed of movement, and conductivity of
part impact heatingExample: Whirlpools
RadiationHeating is transferred from one object through space to
another objectShortwave diathermy, infrared heating and ultraviolet
therapy
ConversionGeneration of heat from another object Example: sound, electricity or chemical agents
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Hydrocollator Packs
EquipmentSilicate gel or clay pads
submersed in 160-170o F water
Maintains heat for 10-20 minutes
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Figure 15-1
IndicationsUsed for general muscle relaxation and reduction
of pain-spasm-ischemia-hypoxia-pain cycleLimitation - unable to heat deeper tissues
effectively
ApplicationPack 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 BathEquipment
Varying sizes used to treat a variety of body partsTank w/ turbine that regulates flow Agitation (amount of movement) is controlled by air emitted
IndicationsCombination of massage and water immersionProvides conduction and convection Swelling, muscle spasm and pain
ApplicationTemperature is set according to treatment goalsAthlete 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 full-
body immersionProper maintenance is
necessary to avoid infection
As volume of body part immersion increases, temperature should decrease
Safety is a major concernElectrical outletsAthlete should not turn
whirlpool on or offContraindicated for acute
injuries due to gravity dependent position
Figure 15-2
Paraffin BathEquipment
A paraffin wax and mineral oil combination, heated to 126-130o F, plastic bags, paper towels and towels
IndicationsUseful in treating chronic injuriesEffective for angular areas of body such as hands, wrists,
elbows, ankles and feetApplication
Body part is cleaned and driedDip 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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FluidotherapyEquipment
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
ApplicationTemperature ranges from 100-113o FParticle agitation should be controlled for comfortPatient should be comfortableTreatment time = 15-20 minutesExercise can be performed while in cabinet
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Figure 15-3 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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CryotherapyUsed 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 ColdType of electromagnetic energy (infrared radiation)Relies on conduction -- degree of cooling depends on
the medium, length of exposure and conductivityAt a temperature of 38.3oF, muscle temperature can be
reduced as deep as 4cmTissue w/ a high water content is an excellent
conductorMost common means of cold therapy are ice packs and
ice immersionWet 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 responseIntermittent 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 cellsDecreases cell metabolic rate and the need for oxygen
through circulation, resulting in less tissue damageDecreased metabolic rate and vasoconstriction
decreases swelling associated w/ inflammatory response
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Decreases muscle spasmMuscle becomes more amenable to stretch as a result of
decreased GTO and muscle spindle activity
Decreases free nerve ending and peripheral nerve excitabilityAnalgesia caused by raising nerve threshold
Cold is more penetrating than heat Ability to decrease muscle fatigue and increase and
maintain muscular contractionAttributed 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)
IndicationsUsed 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 considerationsKeep in mind comfort of the athlete during treatment
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© 2011 McGraw-Hill Higher Education. All rights reserved Figure 15-5
Cold or Ice Water ImmersionEquipment
Variety of basins or containers can be used, small whirlpoolTemperature should be 50-60 degrees F
IndicationsCircumferential cooling of a body part
ApplicationPatient immerses body part in water and goes through four
stages of cold responseTreatment may last 10-15 minutesOnce numb, body part can be removed from immersion and
ROM exercise can be performedAs pain returns re-immersion should take placeCycle 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 messyUseful for approximately 15-20 minutesTowel should be placed between skin and pack
Chemical Cold packsGel packLiquid pack
IndicationsAthlete experiences four stages of
cooling and then proceeds with ROM exercises© 2011 McGraw-Hill Higher Education. All rights reserved
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
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Figure 15-6
Vapocoolant SpraysEquipment
Fluori-methane - non-flammable substance that is released in fine spray from pressurized canister
IndicationsReduces muscle spasm, increases ROM, effective on
trigger point
ApplicationFor 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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© 2011 McGraw-Hill Higher Education. All rights reserved Figure 15-7
CryokineticsTechnique that combines cryotherapy with exerciseGoal is to numb region to point of analgesia and work
towards achieving normal ROMEquipment
Treat area with ice pack, massage or immersion
ApplicationWhen analgesia is experienced, exercises should be
performed (window will last 4-5 minutes)As pain returns, process may be repeatedSequence can be repeated 5 timesExercises should be pain freeChanges in intensity should be limited by both healing and
patient’s perception of pain© 2011 McGraw-Hill Higher Education. All rights reserved
Special Considerations for CryotherapyCooling for an hour at 15.8o - 30.2o F produces
redness 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 conditionsRaynaud’s phenomenonParoxysmal cold hemoglobinuria
Application of ice (very rare) can cause nerve palsyMotor nerves close to skin overexposed to cold (peroneal
nerve at head of fibula)
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Electrical Stimulating CurrentsPhysical Properties of Electricity
Electricity displays magnetic, chemical, mechanical, and thermal effects on tissueVolume of current (ampere)Rate of flow of 1 amp = 1 coulomb Resistance = ohmsForce that current moves along = voltage
Electricity is applied to nerve tissue at certain intensities and duration to reach tissue excitability thresholds resulting in membrane depolarizationTarget sensory, motor, and pain nerve fibers in an effort
to produce specific physiological effects
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EquipmentThree types of units
TENS - transcutaneous electrical nerve stimulatorsNMES/EMS - neuromuscular electrical stimulators or
electrical muscle stimulatorsMENS/LIS - microcurrent electrical nerve stimulators or
low-intensity stimulators
Generate 3 types of currentMonophasic
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© 2011 McGraw-Hill Higher Education. All rights reserved
Biphasic Alternating current where direction of flow reverses during
each cycle
Useful in pain modulation and muscle contractionsPulsatile
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 ParametersWaveforms
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© 2011 McGraw-Hill Higher Education. All rights reserved
Figure 15-10
ModulationAbility of stim unit to change or alter the magnitude
and duration of a waveformMay be continuous, interrupted or surged for both AC
and DC currents Intensity
Voltage output of stimulating unitHigh and low voltage units
Duration (pulse width or pulse duration)Refers to the length of time that current is flowingPre-set on most high voltage DC units
FrequencyNumber of waveform cycles per second
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PolarityDirection of flow -- either positive or negative
Electrode Set-upUse of moist electrodes fixed to the skinCan include monopolar (active and dispersive pad) or
bipolar set-upCurrent 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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IndicationsPain 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 strengtheningHigh frequency AC current; 50-60 pps; 10:50
seconds on/off ratio; 10 repetitions 3x per week; perform with active contractions
Retardation of atrophyHigh frequency AC current 30-60 pps; w/
voluntary muscle contraction encouraged; 15-20 minutes
Muscle re-educationLevel of comfortable contraction -- 30-50 pps;
w/ either interrupted or surge currentAthlete should attempt to contract muscle
along w/ stimTreatment time 15-20 minutes and repeated
multiple times over the course of a week© 2011 McGraw-Hill Higher Education. All rights reserved
Types of Settings
Iontophoresis Introduction of ions into body tissue via direct electrical
currentEquipment
Iontophoresis generator which produces a continuous monophasic current
IndicationsUsed to treat musculoskeletal inflammatory conditions,
analgesic effects, scar modification, wound healing, calcium deposits, hyperhidrosis
MedicationDexamethasone and hydrocortisone are two commonly
used
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ApplicationReusable or commercially produced electrodesThree 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 padMovement of positively and negatively charged ions
relative to electrode charges (poles)Treatment last 10-20 minutes depending on current
intensity and ion concentrations in solutionRequires 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 CurrentsEquipment
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
ApplicationPads must be placed to ensure that current is
centered over painful areaSimilar treatment parameters can be used
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Low Intensity StimulatorsEquipment
Micro-current electrical nerve stimulatorOperates at low frequencies and intensities (sub-sensory)
IndicationsUsed to stimulate healing of soft tissue and boneModulate pain, promote wound healing, promote non-
union fracture healing, tendon and ligament healingBased on theory, little research support
ApplicationUtilizes same electrical currents as previously describedUsing large dispersive pad maintains current density at
thresholds which will not result in sensory nerve depolarization
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Ultrasound TherapyModality which stimulates repair of soft tissue and
pain relief
Form of acoustic energy used for deep tissue heatingOperates at inaudible frequencySound 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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EquipmentHigh 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 MHz1 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 areaProduces a beam of acoustic
energy - collimated cylindrical beam with non-uniform distribution
Variability in the beam (beam non-uniformity 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
IndicationsProduces 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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ApplicationDirect skin application
Requires a coupling medium to provide airtight contact w/ skin and a low friction surface
Underwater applicationUsed for irregularly shaped structuresBody part is submerged in water, ultrasound head is
placed 1” from surfaceWater serves as coupling medium, air bubbles should be
continually swept awaySound head should be moved in circular or longitudinal
patternShould be performed in non-metal container to avoid
reflection
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Gel pad techniqueUsed when body part can not be immersed in waterGel pad applied to treatment areaCoated with gel to enhance contact surface
Moving the transducerLeads to more even distribution of energy, reducing
likelihood of hot spotsShould be moved at a rate of 4cm/secondMust maintain contact of transducer with surface of skinCircular or stroking patterns should be usedShould not treat an area larger than 3 times the ERA
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Dosage and TimeVaries according to depth of tissue to be treated and the
state of injuryDuration tends to last 5-10 minutesIntensity varies
Low 0.1-0.3 W/cm2
Medium 0.4 - 1.5 W/cm2
High 1.5 - 3.0 W/cm2
Special ConsiderationsWhile it is a relatively safe modality, precautions still must
be takenBe careful with anesthetized areas, reduced circulationAvoid 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 goalsUse of hot packs with ultrasound may have an additive
effect on muscle temperatureCold 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
PhonophoresisMethod of driving molecules through the
skin using mechanical vibrationProcess which moves medication to injured tissues
IndicationsPrimarily used to drive hydrocortisone and anesthetics
into the tissueUsed on trigger points, tendinitis and bursitisEffectiveness of treatments is still being exploredGenerally 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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TractionDrawing tension applied to a body segment
Physiological EffectsProduces 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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IndicationsSpinal nerve root impingementDecrease muscle guarding, treat muscle strainTreat sprain of spinal ligamentsRelax discomfort from normal spinal compression
ApplicationManual and traction machines can be usedManual
Adaptable and allows for great flexibilityChanges in force, direction, duration and patient
positioning can be made instantaneously
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Mechanical TractionCan be used to apply cervical or lumbar traction
Positional TractionUsed on trial and error basis to determine maximum position of
comfort to accomplish specific goal
Wall-Mounted TractionCervical traction can be accomplished w/ this unitInvolves use of plates, sand bags or water bags for weightRelatively inexpensive and effective
Inverted TractionUtilizes special equipment or simply inverting ones selfWeight of trunk lengthens spine, providing a stretch
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Figure 15-17
Figure 15-19
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Figure 15-16 Figure 15-
18
Intermittent Compression Units
EquipmentUtilizes nylon inflatable sleeve Sleeve is inflated to specific pressure using either water
or airUtilized to facilitate movement of lymphatic fluids
ParametersAble to adjust on/off time, pressure and treatment time
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IndicationsUsed for controlling or reducing
swelling after acute injuryGood for pitting edema, which
develops several hours after injuryElevation of extremity is critical to
effective treatmentWith electrical stimulation, muscle
pumping can be incorporated to facilitate lymphatic flow
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Figure 15-20
On/Off TimeWill often vary (1:2, 2:1, or 4:1)Not research based
PressuresMust be mindful of blood pressureUpper extremity 30-50 mm HgLower 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-CuffUses both compression
and cold simultaneouslyElevation of cooler results
in increased cuff pressureAlso allows for circulation
of cooler waterPortable and easy to use
Game Ready SystemCirculates water with
compressionCan be customized for
various time, temperature and compression settings
Figure 15-21
MassageSystematic manipulation of soft tissue
Therapeutic EffectsMechanical Responses
Occur as a direct result of pressures and movementsEncourages venous flow and mild stretching of superficial
tissuePhysiological 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 ResponsesTactile system is one of the most sensitive systems
of the bodyBecause 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
EffleurageStroking 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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PetrissageKneadingInvolves picking up
skin between thumb and forefinger, rolling and twisting in opposite directions
Used for deep tissue work Figure 15-25
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FrictionUsed around joints and in areas where tissue is thinAreas w/ underlying scarring, adhesions, spasms and fasciaGoal is to stretch underlying tissue, develop friction and
increase circulation
Figure 15-26
TapotementCupping
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
VibrationRapid movement that produces quivering or trembling
effect to tissueUsed to relax and soothe
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Figure 15-27
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Special ConsiderationsMake the patient comfortable
Positioning, padding, temperature, privacy
Develop confident, gentle approach to massageGood body positioning (clinician and athlete) an develop
good technique
Stroke towards heart to enhance lymphatic and venous drainage
Know when to avoid massageAcute conditions, skin conditions, areas where clots can
become dislodged
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Sports MassageUsually confined to a specific area - rarely
given to full bodyFull body massage is time consuming,
generally not feasibleFive minute treatment can be effectiveMassage lubricants
Enables hands to slide and move easily over body, reducing friction
Rubbing dry area can irritate skinMediums include powder, lotion, oil or liniments
Positioning of AthleteArea must be easily accessible and must be relaxed
Exhibit Confidence
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Ensure Patient Privacy and Athletic Trainer IntegrityDue to direct physical contact professionalism must be
maintained at all timesCritical when dealing with patient of opposite sexBe sure that area being treated is the only area
exposedAn additional athlete or athletic trainer should also be
present
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Deep Transverse Friction MassageTransverse or Cyriax method used to treat muscle,
tendon, ligaments and joint capsulesGoal is mobilization of soft tissueGenerally precedes activityMovement is across the grain of the affected tissueAvoid treatment with acute injuriesTreatment will produce numbing effect allowing for
exercise mobilization
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Acupressure MassageBased on Chinese art of acupuncturePhysiological explanation and effectiveness may be
based on pain modulation mechanismsClinician can utilize acupuncture points in treatmentLocate through measurement of electrical
impedance or palpationSmall circular motions are used to treat points
(pressure to tolerance of athlete = generally more pressure = more effective treatment)
Treatment time ranges from 1-5 minutesCan treat one or more points, working distal to
proximalWill produce dulling or numbing sensation w/ results
lasting from minutes to hours© 2011 McGraw-Hill Higher Education. All rights reserved
Magnet TherapyBecoming popular amongst
competitive and recreational athletes
Used in cases of musculoskeletal ailments
Limited research on magnetic therapy
Utilizes magnetic fields to physiologically impact bodyChange 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© 2011 McGraw-Hill Higher Education. All rights reserved
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 recommendationsRegarding use and maintenance
Failure to follow recommendations = negligence
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Evidence-Based Data Regarding Therapeutic
Modality UseClinical 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 availableEvidence should be carefully questioned and
consideredBest evidence should be put into practice
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