Cryotherapy
• Cold packs, cold bucket baths, and ice massage
are all used in the management of pain and
edema. They are also effective in decreasing
muscle guarding and spasm.
• Body reaction to cryotherapy include initial
vasoconstriction, reduction of tissue metabolism,
decreased nerve conduction velocity, reduction
of muscle spasm, secondary vasodilatation, and
an increase in muscle strength after treatment.
Cryotherapy
• Cold is the modality of choice for acute injuries,
and should be applied as soon as possible, for a
maximum of 20 minutes at a time (with 2 hours
before reapplication), three to four times per day.
• Ice massage, often used for tennis elbow and
shin-splints, involves briskly rubbing ice over the
injured area to produce the desired cold effect;
the advantage is a short treatment of about 5
minutes.
Cryotherapy
• Cold-water compression, using a commercial
sleeve that filled with ice water and available in
different shapes for different body parts,
combines the effects of cold with the effects of
compression. Therapy time is 15 to 20 minutes.
• Cryotherapy should be used with caution on
persons who have thermoregulatory problems,
sensory deficits, hypersensitivity to cold,
impaired circulation, heart disease, and
malignant tissue.
Heating agents
• Beneficial effects of heat therapy include
reducing pain, promotion of healing,
increased range of motion, and muscle
relaxation.
• Body responses include substantially
increased vasodilatation, increased
matabolism, capillary pressure and flow,
clearance of metabolites, and oxygenation
of tissue.
Heating agents
• Since the body naturally responds with changes
similar to the application of heat, heat therapy is
usually only appropriate when the natural
responses have subsided.
• Heat is not typically used until 48-72 hours after
the injury.
• Heat should not be used with athletes who have
impaired circulation, in areas of diminished
sensation, when athletes are heat intolerant, or
in areas susceptible to bleeding.
Hydrotherapy
• Is a form of superficial heating that uses
agitated, heated water in a whirlpool, which is
typically made of stainless steel or fiberglass
and attached to a turbine that mixes air with
water under pressure to produce turbulance.
– Larger areas can be treated and range-of-motion
exercises can be performed.
– Disadvantages include the great amount of time
needed for filling and cleaning, space for the
whirlpool, equipment expense, and the inability to
elevate the body part being treated.
– Treatment time is 10 to 20 minutes.
Contrast Therapy
• Contrast Therapy uses alternating hot and
cold water baths for the ankle, foot, hand,
or elbow.
– It may be used in the subacute stage of an
injury, or 48 to 72 hours after injury to help
reduce swelling and pain and increase range
of motion.
– Contraindications include impaired circulation
as a result of diabetes, vascular disease, and
a tendency to hemorrhage.
Ultrasound
• Ultrasound (ultrasonic diathermy) is a very highfrequency sound wave that is absorbed by tissues high
in protein content, including tendons, ligaments, joint
capsules, and muscle tissue. The sound waves are
transformed into deep heat within the targeted tissue.
– Certified athletic trainers’ use of electrical therapeutic modalities
is limited by some states practice acts, some states permitting
only preparation of the patient, while other states allow a more
active role in clinical settings.
– Ultrasound should not be used over fluid-filled cavities, eyes,
heart, uterus, testes, bone growth plates, fracture sites, artificial
joints, and herniated discs. It is also not recommended during
the acute stage of an injury.
– Treatment is usually 5 to 10 minutes.
Therapeutic Electrical Modalities
• Physicians, physical therapists, and
Certified athletic trainers are the primary
user of therapeutic electrical modalities.
• These modalities achieve their effect by
stimulating nerve tissue without heat or
cold.
Electrical Stimulation (E-Stim)
Therapy
• E-Stim has proven effective in increasing range
of motion and muscle strength, reeducation
muscle, improveing muscle tone, enhancing
function, controlling pain, accelerating wound
healing, and reducing muscle spasm.
• Neuromuscular electrical stimulation (NMES) is
the most common type of E-Stim, which
stimulates a peripheral nerve to cause either a
sensory or a motor response.
• Functional electirical stimulation (FES) is the use
of E-Stim to improve function.
Electrical Stimulation (E-Stim)
Therapy
• Transcutaneous electrical nerve stimulation
(TENS) is commonly applied with a portable unit
for pain control.
• Specialized training is a prerequisite for using
electrical modalities.
• E-Stim should not be used over the carotid
sinus, during pregnancy, in individuals with
pacemakers, on people who are sensitive to
electricity, or any time active motion is
contraindicated.