Unit 9 MODALITIES AND REHABILITATION Lecture Guide Therapeutic Modalities What are they? Therapeutic= Modality= Many different modalities to choose from- selection is dependant on: Smaller, slower nerve fibers carry the Stimulating the larger, faster nerves can close the gate on the smaller slow pain nerves Indications and Contraindications Athletes willingness to accept treatment Must be administered in accordance with local regulations Documentations of all treatments Misuse or overuse of a modality can: Delay the athlete s return to play 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 Types of Modalities Thermotherapy Electrotherapy Translation: Cold, heat, acupuncture, rubbing an injury and chemical irritants can provide relief against pain Cryotherapy PHYSIOLOGICAL Effects Decrease in blood flow Decrease in muscle spasms Decrease in pain perception To maximize effects should be used with RICE Unit NINE - Modalities and Rehabilitation 1 Utah State Office of Education
R.I.C.E Rest Ice Compress Elevate Apply appropriate cryotherapy modality Contraindications Circulatory disturbances Prolonged application Over superficial nerves Longer than 30 minutes = adverse effects Injured body part above heart Stages of Cryotherapy Indications RICE method should be used first 2-3 days of injury Ice for Reapply every 1-2 waking hours Swelling and inflammation present 0-3 minutes after initiation feel cold sensation 2-7 minutes after initiation feel mild burning, aching 5-12 minutes after initiation feel numbness, anesthesia Cryotherpay methods of application Ice massage Sprains Contusions Tendonitis Ice Packs Chemical coolant Flaked or crushed ice in a towel or plastic bag Can be used on any area of body- easiest and simplest. Unit NINE - Modalities and Rehabilitation 2 Utah State Office of Education
Ice Massage Paper cup filled with frozen water to from an ice cylinder Indications No signs of inflammation Tendonitis, muscle spasms, neck strains, bursitis Best done before therapy/ exercise Cold Water Immersion Whirlpool, bucket or container filled with mixture of water and ice- temp- 55-65 degrees Great for hands, feet, ankles or knees Strains Contraindications Acute injury Eyes Chemical coolant Vapocoolant Cold spray Sprayed on surface of skin Effects are temporary and superficial Thermotherapy Physiological Effects Decrease muscle spasm Decrease pain perception Genitals Pregnant abdomen Thermotherapy Methods Moist Heat Packs Monitor often, especially elderly and infants Ultrasound Therapy Increase metabolic rate Increase range of motion Increased general relaxation Unit NINE - Modalities and Rehabilitation 3 Utah State Office of Education
Moist Heat Packs Hydrocollator Packs Silicate gel in a cotton pad immersed in 170 degrees of hot water Layers of towels are placed between skin and pack Superficial heat Whirlpool Bath Tank with a turbine motor which regulates the movement of water and air Reduces swelling, muscle spasm and pain and active movement is also assisted Treatment time is dependant upon area Ultrasound Therapy Contraindications Inflammation Over areas with limited vascularity or sensation Over Ears Heart Reproducitve organs CNS Application of Ultrasound There must be a coupling medium Ultrasound uses high frequency sound waves Sound energy causes molecules in the tissues to vibrate, thus producing heat and micro massage of the tissues Treatment time and intensity the stage of injury and depth of target tissue Best results occur is stretching is performed immediately after Ultrasound Indications Post acute soft tissue trauma Tendonitis Contrast Baths Alternating thermotheapy and cryotherapy Whirlpools, buckets, hot packs and ice bags can be used Vasodialtion-Vasocontriction Unit NINE - Modalities and Rehabilitation 4 Utah State Office of Education
Application Hot: Cold Begin with thermothearpy modality When muscle contractions are not wanted Areas of active bleeding End with cryotherapy modality Electrotherapy application Moist electrode pads are placed on the skin Electrotherapy Physiological Effects Indications Increase blood flow Exercise muscle tissue to decrease atrophy Closer the pads are : The farther apart the pads are: Ice packs, cold water immersion and ultrasound can all be combined with electrotherapy Massage Therapeutic and Physiological Effects Sub-acute injuries Chronic injuries Strains Increasing venous flow and lymphatic drainage Stretches superficial scar tissue Pain Relaxes muscle tissue Contraindications Pregnancy Unit NINE - Modalities and Rehabilitation 5 Utah State Office of Education
Contraindications Hemorrhaging Thromboses Nerve damage Skin Disease Possibility of Calcification Application Use lubricants Be confident Oil, lanolin, lotion, powder Increases venous return to reduce swelling Injured part made easily accessible, comfortable and relaxed Unit NINE - Modalities and Rehabilitation 6 Utah State Office of Education