Beginning Athletic Medicine. Non-Penetrating Therapy

Transcription

1 Beginning Athletic Medicine Non-Penetrating Therapy

2 Therapeutic Modalities What are they? Therapeutic= something that promotes healing and injury repair Modality= the method of application of any therapeutic agent Many different modalities to choose from Selection is dependent on: Prescription Indications and Contraindications Injury site, type and severity Athletes willingness to accept treatment

3 Legal Concerns Must be administered in accordance with local regulations Documentations of all treatments Misuse or overuse of a modality can: Aggravate the condition Delay the athlete s return to play

4 Transmission of Thermal Energy CONDUCTION Heat is transferred from a warmer object to a cooler one Dependent on temperature and exposure time Temperatures of o F will cause tissue damage and temperatures of 113 o F should not be in contact w/ the skin longer than 30 minutes Examples include moist hot packs, paraffin, ice packs and cold packs 2011 McGraw-Hill Higher Education. All rights reserved

5 CONVECTION Transfer of heat through movement of fluids or gases Temperature, speed of movement, and conductivity of part impact heating 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 (sound, electricity or chemical agents) 2011 McGraw-Hill Higher Education. All rights reserved

6 Cryotherapy Thermotherapy Contrast Bath Electrotherapy Massage Types of Modalities

7 Gate Control Theory A principle of pain control There is a gate within the spinal cord that organizes and interpret sensations Larger fast nerve fibers carry sensations such as temperature and pressure Smaller, slower nerve fibers carry the pain sensation Stimulating the larger, faster nerves can close the gate on the smaller slow pain nerves Translation: Cold, heat, acupuncture, rubbing an injury and chemical irritants can provide relief against pain

8 Cryotherapy most common forms are; ice massages, cold immersion, and ice packs. Value: Anesthetic (numbing effect) Reduce spasm (nerve fibers) Increase ROM

9 Cryotherapy PHYSIOLOGICAL Effects Decrease in blood flow Vasoconstriction Decrease in muscle spasms Decrease swelling Decrease in pain perception To maximize effects should be used with PRICE

10 P.R.I.C.E Protection Immobilization Crutches Rest Ice Apply appropriate cryotherapy modality Compress Compression wrap or sleeve, ace bandage Elevate Injured body part above heart May be best method for reducing swelling PRICE method should be used first 2-3 days of injury Ice for minutes and double the time off Reapply every 1-2 waking hours Keep compression on and elevate when possible

11 Cryotherapy Indications Swelling and inflammation present Acute soft tissue injuries Sprains Strains Contusions Spasms Tendonitis Contraindications Allergic Circulatory disturbances Raynaud s phenomenon Prolonged application Over superficial nerves Longer than 30 minutes = adverse effects Hunting Response

12 CRYOTHERAPY When to use: post injury/practice, never before use for at least 24 hours 4 stages of icing Cold Burning- most uncomfortable Aching Numbness

13 Skin response to cryotherapy: Stage 1 Cold Sensation 0 3 min Stage 2 Mild burning, aching 2-7 min Stage 3 Anesthesia 5-12 min

14 Methods of application Ice bag Ice massage Ice immersion Chemical coolant

15 Cryotherapeutic Methods Ice Packs Flaked or crushed ice in a towel or plastic bag Apply for minutes combined with PRICE Can be used on any area of bodyeasiest and simplest. Ice Massage Paper cup filled with frozen water to from an ice cylinder Rub or massage directly over area until skin becomes bright pink- usually for 7-10 min Tendonitis, muscle spasms, neck strains, bursitis

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17 Cryotherapy Methods cont.. Cold Water Immersion Whirlpool, bucket or container filled with mixture of water and ice- temp degrees F Immerse for minutes Great for hands, feet, ankles or knees Can be combined with stretching or exercises Chemical coolant Vapocoolant Cold spray Sprayed on surface of skin Used for myofascial pain and trigger points Effects are temporary and superficial

18 Ice massage Ice Immersion, CWP Ice Pack Equipment Frozen ice cup of water; peel cup back Ice bucket or whirlpool Temp degrees Chemical, bags, crushed ice Indications Application used for small areas or where ice bag is hard to use - shins Rub in overlapping circles min can massage too Preferred for all around cooling After immersion athlete can use cryokinetics approach Numbness, follow up movement patterns Wrap on injured body part, elevate min Consideration s Athlete comfort Frostbite, allow ample time to reheat numb body part. Do not put chemical ice packs directly to the skin.

19 CAUTIONS Those allergic to cold may break out in hives Cold Uticaria Those with less subcutaneous fat have a decreased icing time Don t freeze nerves (lat knee/med elbow) Hunting s response- icing longer than 30 minutes will cause vasodilation

20 Adverse Conditions to Cryotherapy hypothermia frostbite cold allergies Raynaud's phenomenon Hunting response Intermittent period of vasodilation will occur if cooling continues for >20 minutes

21 Raynaud s Phenomenon Raynaud's phenomenon is characterized by a pale to blue to red sequence of color changes of the digits, most commonly after exposure to cold. Raynaud's phenomenon occurs because of spasm of blood vessels.

22 THERMOTHERAPY application of heat to treat traumatic injuries. Heat energy increases activity by conduction, convection, and radiation. Modes are moist, dry, superficial and deep.

23 Thermotherapy Physiological Effects Decrease muscle spasm Decrease pain perception Increased blood flow-vasodilation Increase metabolic rate Decreased joint stiffness Increase range of motion Increased general relaxation

24 Thermotherapy Indications Sub-acute injury No signs of inflammation Best done before therapy/ exercise Tendinitis Strains Spasms Contraindications Acute injury Loss of sensation Eyes Genitals Pregnant abdomen Malignancy Monitor often, especially elderly and infants

25 HEAT THERAPY (THERMAL THERAPY) When used: hours post injury before practice/competition Never after Values: Decreases stiffness Reduces pain Relieve spasm Increases blood flow

26 Thermotherapy Methods Moist Heat Packs Whirlpool Bath Ultrasound Therapy

27 Hydrocollator Packs Silicate gel in a cotton pad immersed in 170 degrees of hot water Apply minutes Layers of towels are placed between skin and pack Superficial heat Moist Heat Packs

28 Whirlpool Bath Tank with a turbine motor which regulates the movement of water and air Creating a hydro massage Reduces swelling, muscle spasm and pain and active movement is also assisted Treatment time is dependent upon area minutes Tank must be drained and cleaned daily to prevent disease transmission

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30 Methods Moist Heat Pack Equipment Hydrocollator packs, 160 degrees. Retain heat for about 20-30min. Terry cloth or towel Warm Whirlpool degressf. Heat min Indication Warms and relax, reduction for spasm. Superficial only convection, reduce swelling, spasms, and pain. Applications Remove pack from water, cover, treat Fill tank, put extremity in and heat Considerations Never! Let athlete sit or lay on heat pack burns Light headedness, electrical outlets, cleanliness

31 Non-Penetrating Modalities Benefits? Restore ROM Decrease inflammation but allow blood and nutrients into the area Change tissue temperature but allow athlete to participate safely Accommodation

32 Contrast Baths Alternating thermotherapy and cryotherapy Whirlpools, buckets, hot packs and ice bags can be used Alternating hot and cold increases local circulation to the treated limb Vasodialtion-Vasocontriction Application 4:1 or 3:1 ratio Hot: Cold Begin with thermotherapy modality End with cryotherapy modality Alternate for minutes

33 CONTRAST Contrast therapy Why? What is the goal? How? Before practice/game? After practice/game?

34 CONTRAST Alternating heat and cold to produce a slight rise or decrease in temperature to increase blood flow without increasing swelling Goals: restore movement bring in nutrients keep inflammation out

35 CONTRAST Flaws: Idea of pumping method vs. Cryokinetics Decrease edema requires that free proteins are removed; this occurs thru the lymph system not the circulatory system. Lymph system is assisted by the mechanical action of muscle not by circulation.

36 CRYOKINETICS Conduction / Convection Allows exercise which is pain-free, relatively soon after injury Ice done initially for up to 20 minutes (typically shorter) to numb the area and decrease the pain Active exercise then follows, done within an amount of time and intensity that does not cause the pain to return

37 CRYOKINETICS Ice is then repeated for 3-5 minutes, followed by 3-5 minutes of exercise Process typically repeated 3-5 times Key to success is progressing as quickly as possible from one exercise to another, until pain returns or fatigue sets in

38 Cryokinetics - Benefits Exercise increases blood flow to injured area, assisting with healing Re-establishes neuromuscular function Makes exercise possible much sooner than normal Decreases muscle atrophy Reduces swelling through combination of cooling and exercise

39 LASER Light Amplification by Stimulated Emission of Radiation Introduced in the 60 s Less pain and inflammation after surgery then conventional

40 Behaves according to the basic laws of light Can be transmitted, reflected, refracted, and absorbed Therapy lasers Lower Lever Laser Therapy (LLLT) Low Intensity Laser Therapy AKA: Cold Laser

41 Laser Sun s photonic rays cause a seed to sprout through RNA & DNA changes. Sun s rays are full-spectrum light, but only one specific wavelength or frequency causes the seed to germinate

42 Has no effect on blood flow Acts on the smallest cellular components of the tissues to jump start the healing process Has been shown to significantly accelerate and enhance the body s natural defense and repair abilities. Pain relief, reduce cell damage due to the injury and resulting loss of function

43 Laser Cell functions are stimulated, especially the increase of a cell s ATP Associated with increase cell metabolism, increased collagen synthesis, stimulation of DNA formation, improved immune system function and increased new formation of capillaries Increase neurotransmitters (serotonin), to increase and enhance tissue regeneration through increasing fibroblasts and keratinocytes. Increase antioxidants and accelerate bone and scar healing

44 Ultrasound Therapy Ultrasound uses high frequency sound waves Sound energy causes molecules in the tissues to vibrate, thus producing heat and micro massage of the tissues

45 Ultrasound Indications Post acute soft tissue trauma Bursitis Tendonitis Fasciitis Contraindications Acute injury Inflammation Over areas with limited vascularity or sensation Over Ears Eyes Heart Reproductive organs Endocrine glands CNS Open growth plates

46 Application of Ultrasound There must be a coupling medium Lotion, gel, water applied to the skin Transducer (sound head) should be kept moving at all times Treatment time and intensity the stage of injury and depth of target tissue Best results occur is stretching is performed immediately after

47 Electrotherapy Physiological Effects Decrease pain Increase blood flow Increase Range of Motion Exercise muscle tissue to decrease atrophy Re-educate muscles

48 Electrotherapy Indications Acute injuries Sub-acute injuries Chronic injuries Swelling Strains Spasms Pain Contraindications Pacemakers Pregnancy When muscle contractions are not wanted Metal implants Areas of active bleeding Near malignancies

49 Electrotherapy application Moist electrode pads are placed on the skin Closer the pads are the shallower and more isolated the muscle contraction The farther apart the pads are, the deeper and more generalized the contraction Active exercise can be used at same time Ice packs, cold water immersion and ultrasound can all be combined with electrotherapy

50 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

51 Indications Used for controlling or reducing swelling after acute injury Elevation of extremity is critical to effective treatment With electrical stimulation, muscle pumping can be incorporated to facilitate lymphatic flow Figure

52 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 mm Hg Lower extremity mm Hg Some units allow for combining cold along with compression Electric stim can also be combined during some treatments

53 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 Figure

54 Massage Systematic manipulation of soft tissue 15-54

55 Massage Therapeutic and Physiological Effects Stimulating Cell metabolism Increasing venous flow and lymphatic drainage Increase circulation and nutrition Stretches superficial scar tissue Relaxes muscle tissue Contraindications Acute injuries Hemorrhaging Infection Thromboses Nerve damage Skin Disease Possibility of Calcification

56 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 15-56

57 Massage Use lubricants Oil, lanolin, lotion, powder Stroke toward the heart Increases venous return to reduce swelling Proper positioning Injured part made easily accessible, comfortable and relaxed Be confident

58 Application Effleurage Stroking divided into light and deep Can be used as a sedative or to move fluids Pressure variations Figure Figure 15-23

59 Petrissage Kneading Involves picking up skin between thumb and forefinger, rolling and twisting in opposite directions Used for deep tissue work Figure

60 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

61 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 Pinching Vibration Lifting of small amounts of tissue between thumb and first finger in quick, gentle pinching movements Rapid movement that produces quivering or trembling effect to tissue Used to relax and soothe 15-61

62 15-62 Figure 15-27

63 Homework Chapter 12 Pages READ! Critical Thinking #1-3 Review questions # 2-5, 8-10