Ch. 12 Therapeutic
Modalities
Objectives
 Explain the use and effectiveness of
physical modalities.
 Describe the various thermal modalities
and their applications.
 Explain and describe the use of
therapeutic ultrasound.
 Explain and describe the use of electrical
modalities.
Modalities
 Various heating, cooling, and electrical
methods of treatment used to promote
healing
 In order to be effective, modalities should
be applied properly
 Helps relieve pain, reduce swelling,
decrease spasm, minimize time lost from
sports
Cryotherapy
 Use of cooling agents
 Ice packs
 Ice massage
 Cold whirlpool
 Coldwater
Compression
 Always monitor
athlete
 Contraindications
 Thermoregulatory
problems
 Sensory deficits
 Hypersensitivity
 Impaired
circulation
 Heart disease
 Malignant tissue
Why ice?
Effects
Vasoconstriction
Reduce tissue metabolism
Decrease nerve conduction
velocity
Reduce muscle spasm
Always use ice for acute
injuries
Ice Bag
 Easy to make, readily
available, cheap
 No air should be in
bag
 May be wrapped on
body
 Reusable ice packs are
better for clinical
setting
 Time: 20 minutes
 May use thin barrier
between ice and skin
Ice Massage
 Freeze water in a
paper cup
 Reusable plastic
cups
 Ideal for
tendonitis, shin
splints
 Time: 5-7 minutes
Cold Whirlpool
 Immersing body
part in cold water
(50°F-60°F)
 Covers the whole
body part
 Athlete may move
body part while
receiving
treatment
 Time: 10 minutes
Cold Compression Unit
 Many different units
that provide cold and
compression to
shoulders, knees, and
ankles
 Some use a pump and
some uses gravity
 Time: 15-20 minutes
Heating Agents
 Superficial and deep tissue heating
 Effects
 Reduce pain
 Increase range of motion
 Muscle relaxation
 Increased vasodilation
 Only use with subacute or chronic injuries
Heat Packs
 Moist heat packs are
kept in a hydrocollator
 Water temp. 140°F to
194°F
 Cover heat pack
before placing on body
 Should be warm but
not burn
 Time: 10-20 minutes
Warm Whirlpool
 Immersing body
part in warm water
(95°F to 104°F)
 Larger part of the
body may be
treated
 Athlete may move
during treatment
 Time: 10-20
minutes
Contrast Therapy
 Alternating hot
and cold therapy
 Used in subacute
stage to reduce
swelling, reduce
pain, and increase
range of motion
Ultrasound
 Deep heating
modality
 High frequency
sound wave
 Can affect tissue
up to 5 cm
 Ideal for tendons,
ligaments, and
joint capsules
 Time: 5-7 minutes
Ultrasound
 Effects
 Increased nerve
conduction velocity
 Increased
extensibility of
collagen rich
structures
 Increased blood flow
 Tissue regeneration
 Stimulating
phagocytosis
 Synthesis of collagen
 Contraindications
 Acute injuries
 Ischemic areas
 Anesthetic areas
 Over cancerous
tumors
 Over active infections
 Over spinal cord
 Over fracture sites
 Around eyes, heart,
skull
Ultrasound Set-Up
 Transducer head: 1 cm², 5 cm², 10 cm²
 Depends on availability and treatment area
 Frequency: 1MHz for deep tissue, 3MHz
for superficial
 Continuous or pulsed setting (Duty Cycle)
 Must use coupling agent
 Move sound head at 2-4 cm/sec
Electrical Stimulation
 Use of electrical
currents to stimulate
the muscle to cause
contractions or spasms
 Different types of
currents
 Different set-ups
 Interferential
 Pre-modulated
Electrical Stimulation
 Effects
 Increase range of
motion
 Increase muscle
strength
 Reeducation muscles
 Improve muscle
tone
 Reduces muscle
spasm
 Control pain
Electrical Stimulation
 Contraindications
 Cardiac disability
 Pacemaker
 Pregnancy (over abdominal area)
 Menstruation
 Over cancerous lesions
 Over sites of infection
 Over exposed metal
 Severe obesity
 Epilepsy