Physical Therapy Modalities for the Office Jeff G. Konin, PhD, PT, ATC, FACSM, FNATA Professor & Chair Physical Therapy Department University of Rhode island
Rehabilitation Interventions Manual Therapy Massage PNF Mobilization/manipulation Mechanical Therapy Physical Agents US, E-Stim, iontophoresis Thermo/Cryo Therapy LASER, Diathermy, Traction Dry Needle
Our Best Modality
Goals Of Rehabilitation Restore Pre-Injury Function Range of motion Strength Pain/Sensory Inflammation Proprioception Gait Posture & Mechanics
Range of Motion Restoration of functional ROM Prevent primary & secondary arthrofibrosis and adhesive capsulitis Early patient education, offset low pain thresholds Manual & mechanical methods Safe advancement teaching AROM, AAROM, PROM, RROM May also decrease accessory motion (instabilities)
Effects of Immobilization Muscle atrophy Muscle & ligament adaptive shortening Bone demineralization General deconditioning Decreased proprioception Compensatory considerations Thrombus/embolism risk All lead to adverse outcomes
Range of Motion Home Education
Measurement Language?
Strength Required to regain function Objectively measure over time Educate on progression avoidance Establish criteria for return to activity
Strength
Pain inhibition can hinder outcomes Pain/Sensory Pain modulation methods are very helpful (Modalities, manual therapies) Sensory integration (scar management, cutaneous nerves, etc.)
Pain/Sensory Pain/spasm cycle reduction is critical Ice vs Heat?
Thermo/Cryo Therapy Cryotherapy - PAIN RELIEF!!!!!!!!!!!!!!!!!!!!! - Reduces acute pain during inflammatory phase, assists with pain-reduced exercise - Combined with compression and elevation can reduce swelling - 20-30 minute application every 2 hours - Pain relief due to decreased NCV Thermotherapy - Increase skin temperature, but not deep tissue or joints - Primary benefits include pain reduction and relief of muscle spasm - Also increase circulation, metabolic activity, inflammation, and tissue elasticity -Decreases viscosity of fluids (bursa) - Heat sensation carried by small diameter fibers (A-delta, C), thus analgesia does not occur via gating mechanism - 20-40 minute Rx may elicit beta-endorphin response supporting Level III model
Methods of Application
Electrical Stimulation Indicated for pain, muscle atrophy, swelling, etc Can be performed with supervision or provided with home unit
E-stim Ultrasound Adjunct with questions
Dry Needling
Inflammation HINDERS FUNCTION! Limits joint range of motion Facilitates neuromuscular inhibition
Rehab can help reduce swelling Inflammation
Neuromuscular Inhibition Pre-synaptic modulation of quadriceps arthrogenic muscle inhibition. Palmieri et al, Knee Surg Sports Traumatol Arthrosc. 2005 Jul;13(5):370-6 Arthrogenic muscle response induced by an experimental knee joint effusion is mediated by pre- and post-synaptic spinal mechanisms. Palmieri RM et al, J Electromyogr Kinesiol. 2004 Dec;14(6):631-40. Arthrogenic muscle inhibition is not present in the limb contralateral to a simulated knee joint effusion. Palmieri RM et al, Am J Phys Med Rehabil. 2003 Dec;82(12):910-6.
Proprioception Diminished following injury Ligament sprains and surgical interventions can lead to joint interference
Proprioception
BOSU Disclaimer The BOSU Balance Trainer is designed to perform a wide variety of exercises with either the dome side up or black platform side up, BOth sides up. However, standing on the platform side of the BOSU Balance Trainer is not recommended, as this information is also stamped on the bottom of the unit. Standing on the dome side offers a balance challenge with the least amount of risk or injury. A woman who broke her hip and wrist while working with a personal trainer at Planet Fitness has settled her lawsuit for $750,000. CT Law Tribune, March 2015
Gait & Weight Bearing What is 25% weight bearing?
Posture & Mechanics
Summary Keep it simple Educate first, then implement Don t assume anything basic is known Use educational materials & resources Early intervention yields best outcomes Refer to Rehab do you really have time in the office for modalities?????