Therapeutic Modalities
Introduction
• Therapeutic modalities create an optimal
environment for injury repair (DO NOT
“CAUSE HEALING”)
• Most common types of modalities
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Cryotherapy (cold)
Thermotherapy (heat)
Massage
Electrical stimulation
Therapeutic ultrasound
Physiology Basics
• Vasodilation
– Increased size of vascular structures
– Means more oxygen to the tissue
• Vasoconstriction
– Decreased size of vascular structures
– Useful for preserving compromised/injured
cells/tissue
Physiology Basics
• Analgesia
– Diminished/reduced sensation
• Metabolic rate
– Activity level of cells
– Reducing MR can preserve cells damaged by
injury
• Inflammation
– Series of events that hinder optimal function
Cryotherapy (Ice)
• Physiological effects
– Decreased local metabolic
rate
• Important in preventing
secondary hypoxic injury
– Decreased local blood flow
• Vasoconstriction
– Decreased presence of
inflammation & the processes
of inflammation
Cryotherapy (Ice)
• Physiological
effects
– Reduced swelling
– Decreased nerve
conduction velocity
• Analgesia- pain
decreased
Cryotherapy (Ice)
• Indications
– Acute injuries
– After activity
– Swelling
– Spasm
– Pain
– Mild burns
Cryotherapy (Ice)
• Contraindications
– Hunting response
• Prolonged exposure to cold may lead to
superficial vasodilation to protect cold bodypart
– Raynaud’s phenomenon
• Cold allergy
Cryotherapy (Ice)
Application
– Ice massage
• 7-10 minutes
• Excellent for muscle spasm
and deep soreness
Cryotherapy (Ice)
Application
– Ice bags, ice towels, or cold
packs
• 15-20 minutes (no longer than 30)
• If using packs, be sure to avoid
direct contact to protect skin!
– Cold whirlpool / ice immersion
• 5-15 minutes, 55-65 degrees
• Duration and temperature
depends on surface area
immersed
Thermotherapy (Heat)
• Physiological effects
– Increased local circulation
• Vasodilation
– Increased local metabolic rate
– Increased collagen extensibility
– Increased nerve conduction velocity
– Analgesia
Thermotherapy (Heat)
• Indications
– Sub-acute injury
– Prior to activity
– Reduce spasm/guarding
• Contraindications
– Acute injury
– Impaired sensation
Thermotherapy (Heat)
• Application
– Warm whirlpool
• Treat 15-20 minutes (no longer than 30)
• 98-110 degrees
– Contrast baths
• Switch back and forth between hot and cold 3:1
or 4:1 to induce “vascular pumping action” from
repeated vasodilation/vasoconstriction
• Particularly useful for troublesome swelling or
edema
Thermotherapy (Heat)
– Hydrocollator
packs
• Treat 20 minutes
• 150-160 degrees
– Will burn!
Must pad
with layered
towels or
covers!
Thermotherapy (Heat)
– Paraffin bath
• Great for angular extremities
(hands & feet)
• 125-127 degrees
• Wash body part
• Dip body part 4-5 times, then
wrap in ice bag and towel
• Treat 20-30 minutes
• Dispose of wax or return to bath
for re-use
• Do not use with open wounds
Massage
• Physiological effects
– Increased local blood flow (if done properly)
– Increased venous/lymph return
– Analgesia & sedative neurological effect
• Indications
– Sub-acute injury
– Soreness
– Persistent swelling
Massage
• Contraindications
– Acute injury (may disturb clotting
mechanism)
– Fracture sites
– Open wounds
Types of Therapeutic
Massage
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Effluerage
Petrissage
Tapotement
Vibration
Cross-friction
Effluerage
• Slow, rhythmic, soothing strokes toward
the heart
• One hand always in contact w/ patient
• Use massage lotion or cream, gloves
optional
• Helps calm/soothe athlete
• Encourages venous & lymph return
Petrissage
• Deeper “kneading” of large muscle
masses
• Stimulates local circulation
• Eliminates muscle trigger points
Tapotement
• Percussion, cupping, or hacking of the
large muscle groups
• Typical “health-spa” massage
• Invigorates- increases neural response
• Increases local circulation
Vibration
• Rhythmic oscillations of larger muscle
groups
– Most often quads and hams
• Physiologically speaking, we are not
really certain of its effects
• Perhaps largest benefit is psychological
Cross-friction
• Best empirically-supported technique
• Increases local blood flow
• Reduces sensation of pain
– Accommodation
• Useful in restoring full function & ROM
• Typical treatment lasts 5 minutes
Electrical Stimulation
• Many types available
– Transcutaneous Electical Nerve
Stimulation (TENS)
• Useful for pain relief
• Portable units are very affordable
• Typically treat for 20 minutes
Electrical Stimulation
• Many types available
– Interferential quad polar (IFQP)
• Uses four pads
• Good for pain control
– Premodulated Bipolar (PMBP)
• Uses two pads
• Good for pain control when IFQP
not ideal (small body parts, etc)
Electrical Stimulation
• Other types also available
• Settings:
– Higher frequencies tend to produce fast
acting, comfortable treatment for acute
injuries, while lower frequencies tend to
elicit longer lasting relief for chronic
injuries
• Typical treatment lasts 15 minutes at
intensity of comfort for patient
Therapeutic Ultrasound
• Sound energy which results in
deep heating to tissue
• May penetrate up to 3-5 cm
when administered a 1 MHz, up
to 1-2 cm at 3 MHz.
• Must keep ultrasound head
moving to prevent burns
• Typical treatment lasts 5-6
minutes at intensity of 1-1.5
w/cm2