the science of therapeutic modalities legal considerations athletic trainers vs. physical...

The Science of Therapeutic The Science of Therapeutic ModalitiesModalities

Legal ConsiderationsLegal ConsiderationsLegal ConsiderationsLegal Considerations

• Athletic Trainers vs. Physical TherapistsAthletic Trainers vs. Physical Therapists

• ChiropractorsChiropractors

• Athletic Trainers vs. Physical TherapistsAthletic Trainers vs. Physical Therapists

• ChiropractorsChiropractors

When Do You Use Therapeutic When Do You Use Therapeutic Modalities?Modalities?

• For First Aid Immediately Following Injury For First Aid Immediately Following Injury

• Throughout The Injury Rehabilitation Throughout The Injury Rehabilitation ProcessProcess

• For First Aid Immediately Following Injury For First Aid Immediately Following Injury

• Throughout The Injury Rehabilitation Throughout The Injury Rehabilitation ProcessProcess

ChoicesChoicesChoicesChoices

• Athletic Trainers Have A Choice Of A Variety of Therapeutic Techniques

• Most All Athletic Trainers Eventually Choose To Use Therapeutic Modalities

• How You Choose To Use A Therapeutic Modality Is An Individual Decision

• The Choice Must Be Based On Theoretical Knowledge And Practical Experience

• Athletic Trainers Have A Choice Of A Variety of Therapeutic Techniques

• Most All Athletic Trainers Eventually Choose To Use Therapeutic Modalities

• How You Choose To Use A Therapeutic Modality Is An Individual Decision

• The Choice Must Be Based On Theoretical Knowledge And Practical Experience

Regardless of Choice Regardless of Choice Remember…..Remember…..

• When Using a Therapeutic Modality In When Using a Therapeutic Modality In Rehabilitation It Should Be Used ONLY As Rehabilitation It Should Be Used ONLY As An Adjunct To Other Forms Of Therapeutic An Adjunct To Other Forms Of Therapeutic ExerciseExercise

How Do We Classify Modalities?How Do We Classify Modalities?How Do We Classify Modalities?How Do We Classify Modalities?

• Therapeutic Modalities Used By Athletic Therapeutic Modalities Used By Athletic Trainers Can Be Classified As Being….Trainers Can Be Classified As Being….– ElectromagneticElectromagnetic– AcousticAcoustic– MechanicalMechanical

RadiationRadiationRadiationRadiation

• Process By Which Energy In Various Process By Which Energy In Various Forms Travels Through SpaceForms Travels Through Space

• Sunlight Is A Form Of Radiant EnergySunlight Is A Form Of Radiant Energy

• Many Modalities Produce Radiant EnergyMany Modalities Produce Radiant Energy

• Process By Which Energy In Various Process By Which Energy In Various Forms Travels Through SpaceForms Travels Through Space

• Sunlight Is A Form Of Radiant EnergySunlight Is A Form Of Radiant Energy

• Many Modalities Produce Radiant EnergyMany Modalities Produce Radiant Energy

RedRed

OrangeOrange

YellowYellow

GreenGreen

BlueBlue

VioletViolet

Electromagnetic RadiationsElectromagnetic Radiations

• Other Forms Of Radiation Other Than Other Forms Of Radiation Other Than Visible Light May Be Produced When An Visible Light May Be Produced When An Electrical Force Is AppliedElectrical Force Is Applied

RedRedRedRed

OrangeOrangeOrangeOrange

YellowYellowYellowYellow

GreenGreenGreenGreen

BlueBlueBlueBlue

VioletVioletVioletViolet

InfraredInfraredInfraredInfrared

UltravioletUltravioletUltravioletUltraviolet

Electromagnetic RadiationsElectromagnetic Radiations

• In Addition, Other Forms Of Radiation In Addition, Other Forms Of Radiation Beyond Infrared And Ultraviolet Regions Beyond Infrared And Ultraviolet Regions May Be Produced When An Electrical May Be Produced When An Electrical Force Is AppliedForce Is Applied

• These Radiations Have Different These Radiations Have Different Wavelengths And Frequencies Than Those Wavelengths And Frequencies Than Those In The Visible Light SpectrumIn The Visible Light Spectrum

• In Addition, Other Forms Of Radiation In Addition, Other Forms Of Radiation Beyond Infrared And Ultraviolet Regions Beyond Infrared And Ultraviolet Regions May Be Produced When An Electrical May Be Produced When An Electrical Force Is AppliedForce Is Applied

• These Radiations Have Different These Radiations Have Different Wavelengths And Frequencies Than Those Wavelengths And Frequencies Than Those In The Visible Light SpectrumIn The Visible Light Spectrum

Collectively The Various Types Collectively The Various Types Of Radiation Form The Of Radiation Form The

Electromagnetic SpectrumElectromagnetic Spectrum

Collectively The Various Types Collectively The Various Types Of Radiation Form The Of Radiation Form The

Electromagnetic SpectrumElectromagnetic Spectrum

Electrical Stimulating CurrentsElectrical Stimulating CurrentsElectrical Stimulating CurrentsElectrical Stimulating Currents

Commercial Radio and TelevisionCommercial Radio and TelevisionCommercial Radio and TelevisionCommercial Radio and Television

Shortwave DiathermyShortwave DiathermyShortwave DiathermyShortwave Diathermy

Microwave DiathermyMicrowave DiathermyMicrowave DiathermyMicrowave Diathermy

InfraredInfraredInfraredInfraredLASERLASERLASERLASER

Visible LightVisible LightVisible LightVisible Light

UltravioletUltravioletUltravioletUltraviolet

Ionizing RadiationIonizing RadiationIonizing RadiationIonizing Radiation

LongestLongestWavelengthWavelength

ShortestShortestWavelengthWavelength

LowestLowestFrequencyFrequency

HighestHighestFrequencyFrequency

Wavelength And FrequencyWavelength And FrequencyWavelength And FrequencyWavelength And Frequency

• Wavelength-Distance Between Peak Of One Wave and Peak of the Next Wave

• Frequency-Number Of Wave Oscillations Or Vibrations Per Second (Hz, CPS, PPS)

• Velocity=Wavelngth X Frequency

• Wavelength-Distance Between Peak Of One Wave and Peak of the Next Wave

• Frequency-Number Of Wave Oscillations Or Vibrations Per Second (Hz, CPS, PPS)

• Velocity=Wavelngth X Frequency

Electromagnetic Radiations Electromagnetic Radiations Share Similar Physical Share Similar Physical

CharacteristicsCharacteristics

• Produced When Sufficient Electrical Or Chemical Forces Are Applied To Any Material

• Travel Readily Through Space At An Equal Velocity (300,000,000 meters/sec)

• Direction Of Travel Is Always In A Straight Line

• Produced When Sufficient Electrical Or Chemical Forces Are Applied To Any Material

• Travel Readily Through Space At An Equal Velocity (300,000,000 meters/sec)

• Direction Of Travel Is Always In A Straight Line

Electromagnetic Radiations Share Similar Physical

Characteristics

Electromagnetic Radiations Share Similar Physical

Characteristics

• When Contacting Biological Tissues May Be…

• When Contacting Biological Tissues May Be…– Reflected

• When Contacting Biological Tissues May Be…– Reflected– Transmitted

• When Contacting Biological Tissues May Be…– Reflected– Transmitted– Refracted

• When Contacting Biological Tissues May Be…– Reflected– Transmitted– Refracted– Absorbed

Laws Governing The Effects of Laws Governing The Effects of Electromagnetic RadiationsElectromagnetic Radiations

• Arndt-Schultz PrincipleArndt-Schultz Principle– No Changes Or Reactions Can Occur In The No Changes Or Reactions Can Occur In The

Tissues Unless The Amount Of Energy Tissues Unless The Amount Of Energy Absorbed Is Sufficient To Stimulate The Absorbed Is Sufficient To Stimulate The Absorbing Tissues Absorbing Tissues

• Arndt-Schultz PrincipleArndt-Schultz Principle– No Changes Or Reactions Can Occur In The No Changes Or Reactions Can Occur In The

Tissues Unless The Amount Of Energy Tissues Unless The Amount Of Energy Absorbed Is Sufficient To Stimulate The Absorbed Is Sufficient To Stimulate The Absorbing Tissues Absorbing Tissues

• Law Of Grotthus-DraperLaw Of Grotthus-Draper– If The Energy Is Not Absorbed It Must Be If The Energy Is Not Absorbed It Must Be

Transmitted To The Deeper TissuesTransmitted To The Deeper Tissues– The Greater The Amount Absorbed The Less The Greater The Amount Absorbed The Less

Transmitted and Thus The Less PenetrationTransmitted and Thus The Less Penetration

• Law Of Grotthus-DraperLaw Of Grotthus-Draper– If The Energy Is Not Absorbed It Must Be If The Energy Is Not Absorbed It Must Be

Transmitted To The Deeper TissuesTransmitted To The Deeper Tissues– The Greater The Amount Absorbed The Less The Greater The Amount Absorbed The Less

Transmitted and Thus The Less PenetrationTransmitted and Thus The Less Penetration

• Cosine LawCosine Law– The Smaller The Angle Between The The Smaller The Angle Between The

Propagating Radiation And The Right Angle, Propagating Radiation And The Right Angle, The Less Radiation Reflected And The Greater The Less Radiation Reflected And The Greater The AbsorptionThe Absorption

• Cosine LawCosine Law– The Smaller The Angle Between The The Smaller The Angle Between The

Propagating Radiation And The Right Angle, Propagating Radiation And The Right Angle, The Less Radiation Reflected And The Greater The Less Radiation Reflected And The Greater The AbsorptionThe Absorption

SourceSource SourceSource

• Inverse Square LawInverse Square Law– The Intensity Of The Intensity Of

The Radiation The Radiation Striking A Surface Striking A Surface Varies Inversely Varies Inversely With The Square With The Square Of The Distance Of The Distance From The SourceFrom The Source

• Inverse Square LawInverse Square Law– The Intensity Of The Intensity Of

The Radiation The Radiation Striking A Surface Striking A Surface Varies Inversely Varies Inversely With The Square With The Square Of The Distance Of The Distance From The SourceFrom The Source

Source

1 Inch

2 Inch

Electromagnetic ModalitiesElectromagnetic Modalities• The Majority of Therapeutic Modalities Used

By Athletic Trainers Emit A Type Of Energy With Wavelengths And Frequencies That Can Be Classified As Electromagnetic Radiations

• The Majority of Therapeutic Modalities Used By Athletic Trainers Emit A Type Of Energy With Wavelengths And Frequencies That Can Be Classified As Electromagnetic Radiations

Electromagnetic Modalities Electromagnetic Modalities Include...Include...

• Electrical Stimulating Currents

• Shortwave And Microwave Diathermy

• Infrared Modalities – Thermotherapy – Cryotherapy

• Ultraviolet Radiation Therapy

• Low-Power Lasers

• Magnet Therapy

• Electrical Stimulating Currents

• Shortwave And Microwave Diathermy

• Infrared Modalities – Thermotherapy – Cryotherapy

• Ultraviolet Radiation Therapy

• Low-Power Lasers

• Magnet Therapy

Electrical Stimulating Electrical Stimulating CurrentsCurrents

• All Can Be Classified As All Can Be Classified As Transcutaneous Electrical Transcutaneous Electrical Stimulating CurrentsStimulating Currents

• Electrical Muscle Electrical Muscle Stimulators (EMS)Stimulators (EMS)

• Transcutaneous Electrical Transcutaneous Electrical Nerve Stimulators (TENS)Nerve Stimulators (TENS)

• Low Intensity Stimulators Low Intensity Stimulators (LIS / MENS)(LIS / MENS)

• All Can Be Classified As All Can Be Classified As Transcutaneous Electrical Transcutaneous Electrical Stimulating CurrentsStimulating Currents

• Electrical Muscle Electrical Muscle Stimulators (EMS)Stimulators (EMS)

• Transcutaneous Electrical Transcutaneous Electrical Nerve Stimulators (TENS)Nerve Stimulators (TENS)

• Low Intensity Stimulators Low Intensity Stimulators (LIS / MENS)(LIS / MENS)

• Russian CurrentsRussian Currents• Interferential Currents Interferential Currents

• Russian CurrentsRussian Currents• Interferential Currents Interferential Currents • Low-Volt Currents Low-Volt Currents

(Iontophoresis)(Iontophoresis)

• Russian CurrentsRussian Currents• Interferential Currents Interferential Currents • Low-Volt Currents Low-Volt Currents

(Iontophoresis)(Iontophoresis)

• Used Primarily For– Pain Modulation– Muscle Contraction– To Create Ion Movement

What Can Electrical Stimulating What Can Electrical Stimulating Currents Be Used For?Currents Be Used For?

• Pain Modulation– Stimulation of sensory cutaneous nerves (Gate

Control) at high frequency i.e. TENS– Production of B-endorphins at lower frequency

i.e. Electroacutherapy

• Pain Modulation– Stimulation of sensory cutaneous nerves (Gate

Control) at high frequency i.e. TENS– Production of B-endorphins at lower frequency

i.e. Electroacutherapy

• Producing Muscle Contraction, Relaxation, And Tetany– Depends On Type Of Current

• Alternating (AC)• Direct (DC)• Polyphasic (Interferential)

– Depends On Frequency (Russian Currents)

• Producing Muscle Contraction, Relaxation, And Tetany– Depends On Type Of Current

• Alternating (AC)• Direct (DC)• Polyphasic (Interferential)

– Depends On Frequency (Russian Currents)

Therapeutic Uses Of Electrically Induced Muscle Contraction

• Muscle Re-education– Biofeedback

• Uses Surface EMG To Measure, Process, And Feedback Reinforcing Information Via Auditory Or Visual Signals

• Helps Athlete Develop Greater Voluntary Control In Terms Of Either Neuromuscular Relaxation Or Muscle Re-education

• Muscle Re-education– Biofeedback

• Uses Surface EMG To Measure, Process, And Feedback Reinforcing Information Via Auditory Or Visual Signals

• Helps Athlete Develop Greater Voluntary Control In Terms Of Either Neuromuscular Relaxation Or Muscle Re-education

Therapeutic Uses Of Electrically Therapeutic Uses Of Electrically Induced Muscle ContractionInduced Muscle Contraction

• Muscle Re-education

• Muscle Pumping Contractions To Reduce Edema

• Retardation Of Atrophy

• Muscle Strengthening

• Increasing Range Of Motion

• Muscle Re-education

• Muscle Pumping Contractions To Reduce Edema

• Retardation Of Atrophy

• Muscle Strengthening

• Increasing Range Of Motion

• Facilitating Soft Tissue And Bone Healing Through Biostimulative Effects– Subsensory Microamperage Currents (LIS)

• Producing a Net Movement Of Ions Through The Use Of Continuous Low-voltage Currents That Elicit A Chemical Change In The Tissues (Iontophoresis)

Shortwave And Microwave Diathermy

DiathermyDiathermyDiathermyDiathermy• High Frequency

Electromagnetic Energy

• Cannot Depolarize Nerve or Muscle

• Both SWD and MWD Used Primarily To Generate Heat In The Tissues

• SWD Also Used For Nonthermal Effects

• High Frequency Electromagnetic Energy

• Cannot Depolarize Nerve or Muscle

• Both SWD and MWD Used Primarily To Generate Heat In The Tissues

• SWD Also Used For Nonthermal Effects

Shortwave DiathermyShortwave DiathermyShortwave DiathermyShortwave Diathermy

• Generators Induce Magnetic And/Or Electrical Fields

• May Be Either Continuous Or Pulsed– Continuous SWD Produces High Frequency

Vibration Of Molecules In Tissues Generating Heat

– Pulsed SWD Causes Repolarization In Damaged Cells Correcting Dysfunction

• Generators Induce Magnetic And/Or Electrical Fields

• May Be Either Continuous Or Pulsed– Continuous SWD Produces High Frequency

Vibration Of Molecules In Tissues Generating Heat

– Pulsed SWD Causes Repolarization In Damaged Cells Correcting Dysfunction

When Should Diathermy Be Used?

• If The Skin Or Some Underlying Soft Tissue Is Tender And Will Not Tolerate Pressure

• In Areas Where Subcutaneous Fat Is Thick And Deep Heating Is Required– Pulsed SWD Produces The Same Magnitude And

Depth Of Muscle Heating as 1MHz Ultrasound (Draper, JAT 1997)

• When The Treatment Goal Is To Increase Tissue Temperatures In A Large Area

• If The Skin Or Some Underlying Soft Tissue Is Tender And Will Not Tolerate Pressure

• In Areas Where Subcutaneous Fat Is Thick And Deep Heating Is Required– Pulsed SWD Produces The Same Magnitude And

Depth Of Muscle Heating as 1MHz Ultrasound (Draper, JAT 1997)

• When The Treatment Goal Is To Increase Tissue Temperatures In A Large Area

InfraredInfrared ModalitiesInfraredInfrared Modalities

• Cold = Cryotherapy

• Heat = Thermotherapy

• Cold = Cryotherapy

• Heat = Thermotherapy

CryotherapyCryotherapy

What Should Cryotherapy Be Used For?

• To Decrease Local Temperature

• To Decrease Local Metabolism

• To Decrease Blood Flow (Vasoconstriction)

• To Decrease Venous And Lymphatic Flow

• To Decrease Nerve Conduction Velocity

• To Decrease Muscle Excitability

• Analgesia

• To Decrease Local Temperature

• To Decrease Local Metabolism

• To Decrease Blood Flow (Vasoconstriction)

• To Decrease Venous And Lymphatic Flow

• To Decrease Nerve Conduction Velocity

• To Decrease Muscle Excitability

• Analgesia

Cryotherapy TechniquesCryotherapy Techniques

• Ice Bags or Ice PacksIce Bags or Ice Packs• Ice Bags or Ice PacksIce Bags or Ice Packs

• Ice Bags or Ice PacksIce Bags or Ice Packs• Ice MassageIce Massage

• Ice Bags or Ice PacksIce Bags or Ice Packs• Ice MassageIce Massage• Fluori-methane Fluori-methane

(Spray and Stretch)(Spray and Stretch)

(Spray and Stretch)(Spray and Stretch)• Contrast BathContrast Bath

ThermotherapyThermotherapy

What Should Thermotherapy Be Used For?

• To Increase Local Temperature• To Increase Local Metabolism• To Increase Blood Flow (Vasodilation)• To Increase Venous And Lymphatic Drainage• To Increase Elasticity of Muscles & Ligaments• To Increase Nerve Conduction Velocity• To Increase Muscle Excitability• Analgesia

Thermotherapy TechniquesThermotherapy TechniquesThermotherapy TechniquesThermotherapy Techniques

• Hydrocollator PacksHydrocollator Packs• Hydrocollator PacksHydrocollator Packs

• Hydrocollator PacksHydrocollator Packs• WhirlpoolsWhirlpools

• Hydrocollator PacksHydrocollator Packs• WhirlpoolsWhirlpools• Paraffin BathsParaffin Baths

• Hydrocollator PacksHydrocollator Packs• WhirlpoolsWhirlpools• Paraffin BathsParaffin Baths• FluidotherapyFluidotherapy

Ultraviolet Light TherapyUltraviolet Light Therapy

What Can Ultraviolet Therapy Be Used For?

• Causes Chemical Changes In Skin That Have A Bactericidal Effect

• Effects Are Primarily Superficial In Nature (<2mm)

• To Treat A Variety Of Skin Lesions Including Acne, Folliculitis, Pityriasis, Tinea, Septic Wounds

• Seldom Used In Treatment Because Of Availability Of Topical Agents

• Causes Chemical Changes In Skin That Have A Bactericidal Effect

• Effects Are Primarily Superficial In Nature (<2mm)

• To Treat A Variety Of Skin Lesions Including Acne, Folliculitis, Pityriasis, Tinea, Septic Wounds

• Seldom Used In Treatment Because Of Availability Of Topical Agents

LASER TherapyLASER Therapy

What Are Low-Power Lasers Used For?

• Helium-Neon (HeNe) & Gallium-Arsenide (GaAs)

• Produces No Thermal Effects

• Soft-tissue And Fracture Healing

• Pain Management

• Not Approved By FDA For Therapeutic Use

• Helium-Neon (HeNe) & Gallium-Arsenide (GaAs)

• Produces No Thermal Effects

• Soft-tissue And Fracture Healing

• Pain Management

• Not Approved By FDA For Therapeutic Use

Magnet TherapyMagnet Therapy

• Despite Popularity No One Really Knows How They Work!!

• Generally Thought To Be Safe

• Despite Popularity No One Really Knows How They Work!!

• Generally Thought To Be Safe

What Are Magnets Used For?What Are Magnets Used For?

• Pain Modulation

• Facilitate Strength

• Explanations– Increased Circulation– Increased Temperature– Changes In pH– Reestablishing Normal Polarity Within The

Injured Cell

• Pain Modulation

• Facilitate Strength

• Explanations– Increased Circulation– Increased Temperature– Changes In pH– Reestablishing Normal Polarity Within The

Injured Cell

Therapeutic UltrasoundTherapeutic Ultrasound

Unlike Other Modalities Ultrasound Is Acoustic Energy

UltrasoundUltrasound

• Frequently Classified With Diathermy As A “Deep Heating” Modality

• Mechanical Vibration• Sound Wave Trans-

formed From High Frequency Electrical Energy

• Frequently Classified With Diathermy As A “Deep Heating” Modality

• Mechanical Vibration• Sound Wave Trans-

formed From High Frequency Electrical Energy

Acoustic EnergyAcoustic Energy

• Cannot Travel Through Space

• Relies On Molecular Collision For Transmission

• More Dense Medium = Higher Velocity Of Travel

• Depth Of Penetration Greater Than Any Form Of Electromagnetic Energy

• Cannot Travel Through Space

• Relies On Molecular Collision For Transmission

• More Dense Medium = Higher Velocity Of Travel

• Depth Of Penetration Greater Than Any Form Of Electromagnetic Energy

What Should Ultrasound Be Used For?

• Thermal Effects Particularly In Deeper Tissues

• Non-Thermal Effects

– To Enhance Healing At Cellular Level

• Thermal Effects Particularly In Deeper Tissues

• Non-Thermal Effects

– To Enhance Healing At Cellular Level

Mechanical ModalitiesMechanical Modalities

Intermittent CompressionIntermittent Compression

• Mechanical Units That Create External Pressure

• Facilitates Venous And Lymphatic Reabsorbtion Of Edema

• Helps Decrease Pain & Increase ROM

• Mechanical Units That Create External Pressure

• Facilitates Venous And Lymphatic Reabsorbtion Of Edema

• Helps Decrease Pain & Increase ROM

TractionTraction

What Should Traction Be Used For?

• To Treat A Variety Of Cervical And Lumbar Spine Problems

– Creates Separation Of Vertebrae

– Alters Proprioceptive Discharge Of Spine

– Stretches Connective Tissue

– Stretches Muscle

– Improves Blood And Lymphatic Flow

– Decreases Pressure On Disk

• To Treat A Variety Of Cervical And Lumbar Spine Problems

– Creates Separation Of Vertebrae

– Alters Proprioceptive Discharge Of Spine

– Stretches Connective Tissue

– Stretches Muscle

– Improves Blood And Lymphatic Flow

– Decreases Pressure On Disk

Traction TechniquesTraction Techniques

• Manual TractionManual Traction• Manual TractionManual Traction

• Manual TractionManual Traction• Traction MachinesTraction Machines

• Manual TractionManual Traction• Traction MachinesTraction Machines• Wall-Mounted Wall-Mounted

TractionTraction

TractionTraction• Inversion TractionInversion Traction

Massage TechniquesMassage Techniques

MassageMassage

• Many Massage Techniques– Hoffa Massage– Acupressure/Shiatsu– Connective Tissue– Myofascial Release– Rolfing– Trager

What Should Massage Be Used For?

• Massage Has Effects On:– Circulation And

Lymphatic Flow– Nervous System– Muscles– Myofascia

• Massage Has Effects On:– Circulation And

Lymphatic Flow– Nervous System– Muscles– Myofascia

– Skin– Scar Tissue– Psychological

Responses– Relaxation– Pain

– Skin– Scar Tissue– Psychological

Responses– Relaxation– Pain

the science of therapeutic modalities legal considerations athletic trainers vs. physical...

radiant energy slide

therapeutic modality

radiant energymany modalities

electrical force

wavelngth x frequency

various forms travels

practical experience

radiant energy process

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